Proposal Form (R06 - ) (PHL-R06-HA)

Transcription

PROPOSAL FORM
SIXTH CALL FOR PROPOSALS
The Global Fund to Fight AIDS, Tuberculosis and Malaria is issuing its Sixth Call for
Proposals for grant funding. This Proposal Form should be used to submit proposals to the
Global Fund. Please read the accompanying Guidelines for Proposals carefully
before filling out the Proposal Form.
Timetable: Sixth Round
Deadline for submission of proposals: 3 August 2006
Board consideration of recommended proposals: 31 October - 3 November 2006
Resources available: Sixth Round
As of the date of the Sixth Call for Proposals, the funding available for this Call is forecast
to be in the range of US$ 0 to US$ 565 million, depending mainly on the amount and
timing of new pledges to the Global Fund. The amount forecast to be available will be
updated on the Global Fund website.
Geneva, 5 May 2006
Rev_PHL Round 6 HIv AIDS Proposal_28Aug06.doc
Index
PROPOSAL SECTIONS FOR COMPLETION BY APPLICANTS
page
1.
Proposal Overview ............................................................................1
2.
Eligibility ............................................................................................3
3.
Applicant & Proposal Endorsement
3A: Applicant Type .........................................................................9
3B: Proposal Endorsement..........................................................18
4.
Component Section.......................................24 and/or 50 and/or 76
5.
Component Budget .......................................40 and/or 66 and/or 92
ATTACHMENTS TO THE PROPOSAL FORM FOR COMPLETION BY APPLICANTS
A.
Targets and Indicators Table (Complete as separate table for each component)
B.
Preliminary Procurement List of Drugs and Health Products
A list of all annexes to be attached to the Proposal Form by the applicant can be found
at the end of sections 3 and 5 the Proposal Form
OTHER REFERENCE DOCUMENTS FOR APPLICANTS
(These and other documents are available at http://www.theglobalfund.org/en/apply/call6/documents/)
Country Coordinating Mechanisms:
The Global Fund’s Revised Guidelines on the Purpose,
Structure and Composition of Country Coordinating
Mechanisms and Requirements for Grant Eligibility
(CCM Guidelines)
Monitoring and Evaluation:
Multi-Agency ‘Monitoring and Evaluation Toolkit’,
Second Edition, January 2006
(M&E Toolkit)
Procurement and Supply Management:
The Global Fund’s “Guide to Writing a Procurement
and Supply Management Plan” (PSM Guide)
i
Index
List of Abbreviations and Acronyms:
AMTP4
BCU
BIHC
BSF
CCM
CHO
COA
COBAC
CRIS
CHD
CSW
DBM
DILG
DOH
FAPs Unit
FSW
HACT
HSRA
IBBIS
IHBSS
IFI
LAC
LBC
LGU
MARPs
MSM
MTPDP
NASA
NCBS
NDHS
NCDPC
NEDA
NHIP
PBC
PMO
PHIC, PhilHealth
PIP
PLWHA
PNAC
PNHA
NASPCP
NCHFD
NEC
NOH
NVBSP
OFW
RNM
SHC
SSESS
STI
VCT
WVMC
Fourth AIDS Medium Term Plan
Blood Collection Unit
Bureau of International Health Cooperation
Blood Service Facility
Country Coordinating Mechanism
City Health Office/ City Health Officer
Commission on Audit
Central Office (DOH) Bids and Awards Committee
Country Response Information System
Center for Health Development (DOH Regional Offices)
Commercial Sex Workers (both gender)
Department of Budget and Management
Department of Interior and Local Government
Department of Health
Foreign Assisted Projects Unit
Female Sex Workers
HIV AIDS Core Team
Health Sector Reform Agenda
Integrated Blood Bank Information System
Integrated HIV Behavioral and Serologic System
International Financing Institutions
Local AIDS Council (LGU Level)
Local Blood Council (LGU Level)
Local Government Unit
Most at Risk Population
Males having Sex with Males
Medium Tern Philippine Development Plan
National AIDS Spending Assessment
National Council for Blood Services
National Demographic and Health Survey
National Center for Disease Prevention and Control
National Economic Development Authority
National Health Insurance Program
Philippine Blood Center
Project Management Office
Philippine Health Insurance Corporation
People in Prostitution
People Living with HIV and AIDS
Philippine National AIDS Council
Philippine National Health Accounts
National AIDS STD Prevention and Control Program
National Center for Health Facility Development (DOH)
National Epidemiology Center (DOH)
National Objectives for Health
National Voluntary Blood Services Program
Overseas Filipino Workers
Resource Needs Model
Social Hygiene Clinic
STI Sentinel Etiologic Surveillance System
Sexually Transmitted Infections
Voluntary Counseling and Testing
Western Visayas Medical Center
ii
How to use this form
1.
Before you start - Ensure that you have all documents that accompany this form:
• The Guidelines for Proposals (Sixth Call for Proposals)
• A complete copy of this Proposal Form
• The Attachments to this Proposal Form.
2.
Please read the accompanying Guidelines for Proposals before filling out this Proposal
Form.
3.
For detailed information on how to use the electronic version of the Proposal Form, please
see Attachment 4 to the Guidelines for Proposals.
4.
In this Proposal Form further guidance for completing specific sections is also included in
the Form itself, printed in blue italics. Where appropriate, indications are given as to the
approximate length of the answer. Please try to respect these indications.
5.
To avoid duplication of effort, we recommend you to make maximum use of existing
information (e.g., program documents written for other donors/funding agencies).
6.
Complete the Checklists at the end of sections 3 and 5 of the Proposal Form to ensure that
you are sending a fully completed proposal.
7.
Attach all documents requested throughout the Proposal Form.
8.
Consult our “Frequently Asked Questions” link:
http://www.theglobalfund.org/en/apply/call6/
Please note that any information submitted to the Global Fund may be made publicly
available.
WHAT IS DIFFERENT COMPARED TO ROUND 5?
The main difference compared to the Round 5 Proposal Form is that Health Systems
Strengthening is no longer a separate component. It is important to recognize that applicants
can still apply for funding for health systems strengthening activities by including such activities
in the specific disease components.
In other respects the Round 6 Proposal Form is similar to the Round 5 Proposal Form, and
changes have mainly been made for the purpose of improved clarity and presentation.
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1 Proposal Overview
1.1 General information on proposal
Applicant Name
Country/countries
Philippines
Applicant Type
Please tick one of the boxes below, to indicate the type of applicant. For more information, please refer to the
Guidelines for Proposals, section 1.1 and 3A.
National Country Coordinating Mechanism
Sub-national Country Coordinating Mechanism
Regional Coordinating Mechanism (including small island developing states)
Regional Organization
Non-Country Coordinating Mechanism Applicant
Proposal component(s) and title(s)
Please tick the appropriate box or boxes below, to indicate components included within your proposal. Also specify the
title for each proposal component chosen. For more information, please refer to the Guidelines for Proposals, section
1.1.
Component
HIV/AIDS1
Title
Scaling Up HIV Prevention, Treatment, Care and Support Through
Enhanced Voluntary Counselling and Testing and Improved Blood Safety
Strategies
Tuberculosis1
Malaria
Currency in which the Proposal is submitted
Please tick the appropriate box. Please note that all financial amounts appearing in the proposal should be
denominated in the selected currency only.
US$
Euro
1
In contexts where HIV/AIDS is driving the tuberculosis epidemic, HIV/AIDS and/or tuberculosis components should include
collaborative tuberculosis/HIV activities. Different tuberculosis and HIV/AIDS activities are recommended for different epidemic
states; for further information see the ‘WHO Interim policy on collaborative TB/HIV activities,’ available at
http://www.who.int/tb/publications/tbhiv_interim_policy/en/.
1
1 Proposal Overview
1.2 Proposal funding summary per component
Funds requested for each component (i.e. HIV/AIDS, tuberculosis and/or malaria) in table 1.2 below must be the
same as the totals of the corresponding component budget in table 5.1.
Table 1.2 – Total funding summary
Total funds requested (US$)
Component
HIV/AIDS
Tuberculosis
Year 1
Year 2
Year 3
Year 4
Year 5
Total
4,574,130
2,900,834
3,793,418
3,455,221
3,710,587
18,434,190
0
0
0
0
0
0
0
0
0
0
0
0
Malaria
Total
1.3 Previous Global Fund grants
Table 1.3 – Previous Global Fund grants
Previous grants
Component
Rounds
Current Amount* (US$)
HIV/AIDS
Round 3 and Round 5
US$ 12,006,887.00
Tuberculosis
Round 2 and Round 5
US$ 58,635,707.50
Malaria
Round 2 and Round 5
US$ 26,138,181.00
HSS/Other
*
Aggregate all past grants, including approved but as yet unsigned amounts. These amounts should include Phase 2
where this has been approved/signed. For more detailed information, see the Guidelines for Proposals, section 1.3.
2
2 Eligibility
Only those Proposals that meet the Global Fund’s eligibility criteria will be reviewed by the
Technical Review Panel.
Eligibility is a multi-step process that depends on the income level of the country (or countries) applying for funding and,
in some cases, disease burden.
Please read through this section carefully and consult the Guidelines for Proposals, section 2, for further guidance on the
steps to be followed by each applicant.
2.1 Technical eligibility
2.1.1 Country income level
Please tick the appropriate box in the table below. For proposals from multiple countries, complete the
referenced information separately for each country (see the Guidelines for Proposals, section 2.1).
Country/countries
Low-income
Î Complete section 2.2 only
Lower-middle income
Î Complete sections 2.1.2, 2.1.3 and 2.2
Upper-middle income
Î Complete sections 2.1.2, 1.2.3, 2.1.4 and 2.2
3
2 Eligibility
2.1.2 Counterpart financing and greater reliance on domestic resources
Please enter information on counterpart financing in table 2.1.2 below if the country(ies) listed above are classified as Lowermiddle income or Upper-middle income.
Non-CCM Applicants do not have to fulfill the counterpart financing requirement.
The table should be filled in for each component included in this proposal. For definitions and details of counterpart financing
requirements, see the Guidelines for Proposals, section 2.1.2.
Important note: The field “Total requested from the Global Fund” in table 2.1.2 below should equal the request in section 5 and
table 5.1 for each corresponding component.
Table 2.1.2 – Counterpart financing
(in US$)
Component
Financing sources
Year 1
HIV/AIDS
Year 2
Year 3
estimate
Year 4
estimate
Year 5
estimate
Total requested from
the Global Fund (A)
[from table 5.1]
4,574,130
2,900,834
3,793,418
3,455,221
3,710,587
Counterpart
financing (B) [linked
to the disease control
program] ª º
5,665,982
5,835,961
6,011,040
6,191,372
6,377,112
Counterpart financing
as a percentage of
total financing:
[B/(A+B)] x 100 = %
55.33%
66.79%
61.31%
64.18%
63.22%
ª includes budget (Personnel & MOOE) from national , approximate value for local governments, and 3
government loans, namely:
1. Condom social marketing – grant from KfW US $ 12,000,000 from 2005-2010 (taken as 100% HIV Program)
2. Second Women’s Health and Safe Motherhood – loan from WB US $ 32,700,000 (taken as 10% HIV Program)
3. Upgrading of 5 Hospitals, 3 of which are treatment hubs (DMC, Bicol Regional and VSSMMC) – loan from
Netherlands (taken as 20% HIV Program)
º
4
2 Eligibility
(Euro / US$)
Component
Financing sources
Year 1
Year 2
Year 3
estimate
Year 4
estimate
Year 5
estimate
the Global Fund (A)
[from table 5.1]
Malaria
Counterpart
program]
as a percentage of
total financing:
[B/(A+B)] x 100 = %
2.1.3 Focus on poor or vulnerable populations
All proposals from Lower-middle income and Upper-middle income countries must demonstrate a focus on poor
or vulnerable population groups. Proposals may focus on both population groups but must focus on at least one
of the two groups. Complete this section in respect of each component.
Describe which poor and/or vulnerable population groups your proposal is targeting; why and how
these populations groups have been identified; how they were involved in proposal development and
planning;
and
how
they
will
be
involved
in
implementing
the
proposal
(Maximum half a page per component).
The proposal targets the clientele of the public health facilities, which includes the people most at risk and
vulnerable for HIV infection (sex workers, males having sex with males, migrant workers and their
partners), pregnant HIV positive mothers, people living with HIV and AIDS and the blood donors. Social
Hygiene Clinics (SHC) primarily focused its services to female sex workers, MSM, intravenous drug users
and other women client. Studies have shown that people accessing the public services belong to the lower
socio-economic status of the population. The target populations were selected based on the increasing
demand for HIV and STI related services as a result of intensified outreach, increased awareness and
availability of treatment care and support services for people living with HIV and AIDS (PLWHA). The
proposal will complement the existing prevention efforts. Intensified VCT will focus to most at risk
population (MARP), migrant workers and other general population at SHC and hospital facilities.
Blood services will be focused to all income levels. However, big proportion of ‘hidden paid donors’
conniving with patients’ relatives and receiving payments for a blood donation are economically poor and
maybe vulnerable. These people will benefit from intensified VCT Services thru establishment of referral
system from blood service facilities to HIV services facilities. In addition, communities in general will benefit
from public education and mass media. The blood program actively participated in the development of the
proposal and will be the direct implementer of the project’s blood program component.
Under the GIPA principle, PLWHAs were involved in the formulation of this proposal and will be active
partners in the decision-making and project implementation. Organizations of PLWHAs and other
vulnerable groups shall also be tapped to plan, implement and evaluate the project. The PLWHA
organizations’ capacity for project implementation will be built up and active participation and involvement
will be expected.
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2 Eligibility
2.1.4 High disease burden
Proposals from Upper-middle income countries must also demonstrate that they face a very high current disease
burden. Please enter such information in the section below in respect of each component. Please note that if the
applicant country falls under the “small island economy” lending eligibility exception as classified by the World
Bank/International Development Association, this requirement does not apply (see section C in Attachment 1 to
the Guidelines for Proposals).
Confirm that the country(ies) is(are) facing a very high current disease burden, as evidenced by data
from WHO and UNAIDS. (Please see the Guidelines for Proposals, section 2.1.4 for more information on the
definition of high disease burden.)
Since 1993, Philippines has been categorized as low level HIV epidemic. However, in 2004, with the
increasing number of people in prostitution, increasing incidence of STI and detection of HIV positive
cases among injecting drug users in 2005, the epidemic in the country has been re categorized as
“hidden and growing”. Also, high poverty incidence and unstable social support structure have increased
the vulnerability of Filipinos to infectious diseases such as tuberculosis, malaria and HIV and AIDS.
Stigma and discrimination had also prevented PLWHAs to come out in the open making access to
essential HIV services more difficult to PLWHAs.
National HIV prevalence among adult population is low at (<0.1%-<0.2%) but indications of increasing
number of new HIV infections are starting to show in a number of indicators: (1) during the last decade
the average number of reported cases has doubled from 100 cases per year from 1993 to 2001 to 200
cases per year in the last 3 years; Sexually transmitted infections has been persistently high for both the
most at risk population (FSW and MSM) and the general population; (3) HIV transmission thru needle
sharing has been reported in the last round of surveillance (2 cases) which had never happened since
1996; (4) number of people engaging in risky behaviors is increasing as a result of poverty and other
socio economic challenges; (5) migrant workers outside of the country constitute almost 10% of the total
population and the increased mobility and work related factors abroad has increased the likelihood of
acquiring HIV infections; (6) the youth has an earlier sexual debut in addition to the high misconception
and low level of knowledge on how to prevent HIV and AIDS; and lastly, (7) the number of positive HIV
cases among blood donors has doubled in the last 4 years from 4/100,000 in 2000 to 8/100,000 in 2004.
It is said that all pre-conditions for a major epidemic is already present in the country and that the lack of
concrete information and evidences are among the many reasons why the numbers are quite low.
2.2 Functioning of Coordinating Mechanism
To be eligible for funding, all applicants, other than Non-CCM Applicants and Regional Organizations
must meet the Global Fund’s minimum requirements for Coordinating Mechanisms.
For additional information regarding these requirements, see:
•
•
The Guidelines for Proposals, section 2.2 and
The CCM Guidelines.
Please note that your application must provide documentation to show how the applicant
meets these minimum requirements. You will be asked to re-confirm this in the Checklist at the
end of section 3.
2.2.1 Broad and inclusive membership
a) People living with and/or affected by the disease(s)
Provide evidence of membership of people living with and/or affected by the disease(s).
(This may be done by demonstrating corresponding Coordinating Mechanism membership composition and
endorsement in table 3B1.2, and 3B.1.3 in section 3B of the Proposal Form.)
All members of the CCM are treated as equal partners in the mechanism, with full rights to participation,
expression and involvement in decision-making in line with their areas of expertise. Voting rights will be
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2 Eligibility
reserved to one per organization. The CCM also ensures that all relevant players are involved in the
process and provides transparency to the general public. As such, it is responsible for ensuring that
information related to the Global Fund (such as Calls for Proposals - Annex 3), decisions taken by the
CCM, and detailed information on approved proposals for funding, are disseminated widely to all
interested parties in the country.
The CCM has representatives from persons living with the disease, Samahang Lusog Baga (SLB) for
tuberculosis and Positive Action Foundation Philippines, Inc. (PAFPI) for HIV/AIDS as reflected in the
CCM’s organizational chart. Pinoy Plus, also an organization of people living with the disease (HIV) are
also seating in the CCM as alternate for the PAFPI. Pinoy Plus is also a member of the Technical
Working Group for HIV/AIDS of the CCM. (Annex 1)
b) Selection of non-governmental sector representatives
Provide evidence of how those Coordinating Mechanism (CM) members representing each of
the non-governmental sectors (i.e. academic/educational sector, NGOs and community-based
organizations, private sector, religious and faith-based organizations, and multi-/bilateral
development partners in country) have been selected by their own sector(s) based on a
documented, transparent process developed within their own sector.
(Please summarize the process and, for each sector, attach as an annex the documents showing the
sector’s transparent process for CM representative selection, and the sector’s minutes or other
documentation recording the selection of their current representative. Please indicate the applicable annex
number.)
The First Philippine Partnership Meeting among the government agencies, academe, civil society
organizations, multilateral and bilateral organizations was held in June 2002, which became the venue for
election of memberships to the CCM and constitution of the CCM bylaws and guidelines. The forum was
attended by international, bilateral, donor agencies, coalitions, public and private stakeholders, academe,
civil society organization and organizations of people living with the disease. During the Partnership
Meeting, there was a breakout session where participants were asked to identify which sector they belong
and elect a representative member for each sector. During the breakout session, the draft document of the
Mission, Vision Statements of the Partnership was also discussed. In the said meeting , four members of
the CCM were appointed as permanent members, namely the Department of Health (DOH), World Health
Organization (WHO), UNAIDS and Positive Action Foundation Inc. (PAFPI), a PLWHA group. The
documentation was part of the proceedings of the forum. (Annex 2)
On World TB Day, March 24, 2006, the Philippine Coalition Against Tuberculosis (PhilCAT)organized a
forum for the launch of the Global Plan 2 for TB. During that forum, all stakeholders in the Philippine
Partnership against TB, Malaria, and AIDS were invited to attend and during the specified period from
3:00 to 8:00 PM. Invitees were requested to cast their ballots for the open CCM slots. The vacancy was a
result of expiration of membership tenure (2 years for non permanent members). Organizations present
during the First Partnership Meeting were among the nominated. The election was done under the
supervision of the Commission on Election that was organized by the Country Coordinating Mechanism.
A total of 45 stakeholders cast their votes and the new members of the Private Sector Representatives to
the Country Coordinating Mechanism were elected at that time. The New members were invited to attend
the June CCM meeting. (Annex 3)
2.2.2 Documented procedures for the management of conflicts of interest
Where the Chair and/or Vice-Chair of the Coordinating Mechanism are from the same entity as the
nominated Principal Recipient(s) in this proposal, describe and provide evidence of the applicant’s
documented conflict of interest policy to mitigate any actual or potential conflicts of interest arising in
regard to the applicant’s operations or responsibilities.
(Please summarize and attach the policy as an annex. Please indicate the applicable annex number.)
Conflict of interest matters are handled by the CCM based on its existing policies and guidelines. Based
on the CCM guidelines, Principal Recipient cannot be the Chair and the Chair and Vice Chair should
come from different sectors. (Annex 2) The DOH was nominated and approved by the CCM to be the
Principal Recipient (PR) which was in conflict with the Chairmanship of the CCM. During the approval of
7
2 Eligibility
the HIV and AIDS proposal for endorsement to GFATM (July 18), the CCM discussed the conflict of
interest matter in which it was agreed that DOH as PR shall inhibit or abstain in the deliberation and
discussions of Round 6 HIV/AIDS Component. (Annex 4)
2.2.3 Documented and transparent processes of the Coordinating Mechanism
As part of the eligibility screening process for proposals, the Global Fund will review supporting documentation
setting out the CCM’s proposal development process, the submission and review process, the nomination
process for Principal Recipient(s), as well as the minutes of the meeting where the CCM decided on the
elements to be included in the proposal and made the decision about the Principal Recipient(s) for this
proposal.
Please describe and provide evidence of the CCM’s documented, transparent and
established:
a) Process to solicit submissions for possible integration into this proposal.
(Please summarize and attach documentation as an annex and indicate the applicable annex number.)
There was an announcement last March 2006 within the CCM that the Call for Proposal for Round 6 has
been issued by Global Fund. In the succeeding regular meeting, the Department of Health (DOH)
expressed its intention to come up with a national proposal for HIV and AIDS Component under Round 6.
(Annex 5) The concept was presented and approved in the June 13 CCM meeting including the CCM
agreement for DOH to take the lead as PR for the said proposal. (Annex 6) The CCM published in a paper
of national circulation a ‘Call for Concept Paper for HIV/AIDS and Malaria’ on July 1. (Annex 7)
Submissions related to the approved concept were integrated to the proposal. In the July 18, 2006
meeting of the CCM, the HIV and AIDS proposal was approved in principle pending minor revisions on
the budget. (Annex 4)
b) Process to review submissions received by the CCM for possible integration into this proposal.
The national call for concept papers was published in a newspaper of national circulation on July 1, 2006.
(Annex 7) Three concepts on HIV/AIDS Component were submitted to the CCM Secretariat. The concepts
were presented to the Philippine National AIDS Council. During the discussion, the group agreed on what
concepts could be integrated in the HIV and AIDS round 6 proposal. One concept on migrant workers
was considered for inclusion in the operational research component. The concept regarding the campus
youth HIV AIDS advocacy and that of an information system software were deferred.
c) Process to nominate the Principal Recipient(s) and oversee program implementation.
The DOH expressed its intention to apply as Principal Recipient during the CCM meeting in June. The
CCM welcomed the move and during the deliberation, it acknowledged the DOH proposal as PR. It was
further discussed and agreed upon in the July 18 meeting during the approval of the proposal. (Annex 6;
Annex 4)
d) Process to ensure the input of a broad range of stakeholders, including CCM members and
non-CCM members, in the proposal development process and grant oversight process.
A technical working group was formed in the Department of Health (DOH) to work on the proposal
development. Membership comes from key DOH offices (National AIDS/STD Prevention and Control
Program, National Voluntary Blood Services Program, National Epidemiology Center), Philippine National
AIDS Council secretariat, UNAIDS and WHO. Membership expanded to GTZ, Philippine Blood Center,
Bureau of International Health Cooperation of DOH, DOH Finance Service and civil society
organizations(annex 8). Series of consultative workshops were conducted wherein broad range of
8
2 Eligibility
stakeholders actively participated (San Lazaro Hospital, STD/AIDS Central Cooperative Laboratory,
Department of Interior and Local Government, Remedios AIDS Foundation and Positive Action
Foundation Philippines - PLWHA organization).
9
LIST OF ANNEXES TO BE ATTACHED TO PROPOSAL
This section contains information on the applicant. Please see the Guidelines for Proposals, section 3A, for more
information regarding the nature of different applicants.
All Coordinating Mechanism Applicants (whether national, sub-national, regional (C)CMs) and Regional
Organizations must also complete section 3B of this Proposal Form and provide the documented evidence requested.
Non-CCM Applicants do not complete section 3B. These applicants must fully complete section 3A.5 of this Proposal
Form and provide documentation as an attachment to this proposal supporting their claim to be considered as eligible for
Global Fund support outside of a Coordinating Mechanism structure.
3A.1 Applicant
Table 3A.1 – Applicant
Please tick the appropriate box in the table below, and then go to the relevant section in this Proposal Form, as
indicated on the right hand side of the table.
National Country Coordinating Mechanism
Îcomplete sections 3A.2 and 3B
Sub-national Country Coordinating Mechanism
Regional Coordinating Mechanism
(including small island developing states)
Regional Organization
Îcomplete section 3A.5 and 3B
Non-CCM Applicants
Îcomplete section 3A.6
10
3A.2 National Country Coordinating Mechanism (CCM)
For more information, please refer to the Guidelines for Proposals, section 3A.2, and the CCM Guidelines.
Table 3A.2 – National CCM: basic information
Name of national CCM
Date of composition (yyyy/mm/dd)
Philippine Country Coordinating Mechanism
2002/05/05
3A.2.1 Mode of operation
Describe how the national CCM operates. In particular:
• The extent to which the CCM acts as a partnership between government and other
actors in civil society, including the academic and educational sector; non-government and
community-based organizations; people living with and/or affected by the diseases and the
organizations that support them; the private sector; religious and faith-based organizations; and
multi-/bilateral development partners in-country; and
• How it coordinates its activities with other national structures (such as National AIDS
Councils, Parliamentary Health Commissions, National Monitoring and Evaluation Offices and
other key bodies).
(For example, address topics including decision-making mechanisms and rules, constituency consultation
processes, the structure and key focus of any sub-committees, frequency of meetings, implementation
oversight processes, etc. The recommended length of response is a maximum of one page. Please provide
terms of reference, statutes, by-laws or other governance documentation relevant to the CCM, and a diagram
setting out the interrelationships between all key actors in the country as an annex to this proposal. Please
indicate the applicable annex number.)
The CCM is a stand-alone organization composed of a broad representation from both public and private
sectors and is a private public partnership drawing from members of the civil society that have been
elected in a transparent and well documented manner. Members from external partners such as United
Nations agencies, bilateral and development partners and donor countries to the GF are selected
separately through mechanisms that are supervised by the office of the WHO Country Representative.
The civil society representatives are broadly categorized into: 1. Academe, 2. People Living with the
Disease, 3. Private Professional Organizations, 4. Non Government Organizations, 5. Faith Based
Organizations and 6. Public-Private coalitions involved in the control and/or advocacy for the three
diseases. The composition of the CCM is shown in the organizational chart. (Annex 1) The election of the
civil society representatives to the CCM was held in a transparent, open, and well documented process
using the election guidelines for the CCM. (Annex 3) CCM members representing these various
stakeholders are present in all CCM meetings and are invited to join monitoring meetings of the GF
projects. They are likewise enjoined to inform their respective sector constituents regarding the matters
taken up by the CCM for information and for consultation.
There are a total of 35 members of the CCM. Of these, 10 (40%) are from the public sector and 25 (60%)
are from the non-government sector comprising of 2 from the academe, 6 from NGOs, 2 from people living
with the disease, 2 from faith based organizations, 2 from private sector, 3 from coalitions, and 8 from UN
agencies and developmental bilateral partners or government of donor countries to the GF. CCM
members are responsible for the dissemination of the CCM proceedings to their own constituents. In the
deliberation of the coordinated country proposals, these various agencies are encouraged to contribute in
the proposal. They are likewise encouraged to join the monitoring and supervision visits to be informed of
the status of the GF project implementation.
As far as the National Monitoring and Evaluation is concerned, in the DOH, this function is vested on the
National Epidemiology Center (NEC). The various component projects of the GF in AIDS, TB, and
malaria support the development of capacity at the NEC to deliver on this activity by the development of
the SSESS for STIs and CRIS for AIDS, ETR for TB, and PhilMIS for Malaria. All these programs are
intended for the use of the NEC to harmonize GF monitoring and evaluation with the DOH central office
11
responsible for the undertaking. Presently, CCM is Chaired by an Undersecretary of the Department of
Health, and Vice-Chaired by USAID. The CCM functions as a national consensus group to promote true
partnership in the development and implementation of the Global Fund supported programs as well as
ensure full transparency in its decision-making. All members of the CCM are treated as equal partners in
the mechanism, with full rights to participation, expression and involvement in decision-making in line with
their areas of expertise. Voting rights will be reserved to one per organization. The CCM conducts
regular meeting at least twice every quarter but may call for special meetings as needs arise. (Annex 2).
Î After completing this section, complete section 3B.1.
12
3B.1
Coordinating Mechanism membership and endorsement:
All national, sub-national and regional Coordinating Mechanisms must complete this section.
Organizations must complete section 3B.2.
Regional
National/Sub-national/Regional Coordinating Mechanisms
3B.1.1 Leadership of Coordinating Mechanism
Table 3B.1.1 – National/Sub-national/Regional (C)CM leadership information
(not applicable to Non-CCM and Regional Organization applicants)
Chair
Vice Chair
Name
Usec. Ethelyn P. Nieto
Dr. Aye Aye Thwin
Title
Undersecretary of Health
Chief , Office for Population, Health
& Nutrition
Organization
United States Agency for
International Development (USAID)
Mailing address
Bldg. 2, DOH Compound, Rizal
Avenue, Sta. Cruz, Manila
8/F PNB Financial Center, Pres. D.
Macapagal Blvd., Pasay City
Telephone
+63 2 711 6067
+63 2 552 9865
Fax
+63 2 712 5866
+63 2 552 9865
E-mail address
[email protected]
[email protected],
[email protected];
[email protected]
13
3B.1.2 Membership information
Please note that to be eligible for funding, national/sub-national/regional Coordinating Mechanisms must demonstrate
evidence of membership of people living with and/or affected by the diseases. It is recommended that the membership of the
CCM comprise a minimum of 40% representation from non-governmental sectors. For more information on this, see the
Guidelines for Proposals section 3B.1, and the CCM Guidelines.
The table below must be completed for each national/sub-national/regional Coordinating Mechanism member, and the table
will therefore need to be extended to cover numerous members.
Under “Type”, please specify which sector the CCM member represents: academic/educational; government; nongovernmental and community-based organizations; people living with HIV/AIDS, tuberculosis and/or malaria; the private
sector; religious/faith-based organizations; or multi-/bilateral development partners in country.
Table 3B.1.2 – National/sub-national/regional (C)CM member information
3
Member
Agency/organization
Positive Action Foundation Philippines, Inc.
Website
Type
People Living with the Disease
Mailing address
2361 Dian St. Malate, 1004 Manila, MM
Sector Represented
People living with HIV/AIDS
E-mail address
[email protected]
Name of representative
Mr. Joshua Formentera
CCM member
since
September 2002
Title in agency
President
Fax
63(2)404-2911
Proposal development; proposal review;
proposal Review Panel
Telephone
63(2)832-6239
Role in CCM and in Proposal
Development
4
Member
Agency/organization
Pilipinas Shell Foundation, Inc (PSFI)
Website
Type
Private Corporation
Mailing address
Castillan Hall, Asturia Hotel, Tinigulban, Puerto
Princesa City, Palawan
Sector Represented
Private Sector
E-mail address
[email protected]
Ms. Marvi Trudeau
CCM member
since
September 2002
Title in agency
Program Manager
Fax
(63-48) 434-5203
Role in CCM and in Proposal
Development
Proposal Review Panel
Telephone
(63-48) 434-5202
5
Member
Agency/organization
Philippine Coalition Against Tuberculosis
(PhilCAT)
Website
Type
Non-Government Organization
Mailing address
Sector Represented
E-mail address
Dr. Jubert P. Benedicto
CCM member
since
September 2002
Title in agency
Chairperson
Fax
63(2)749-8990
Role in CCM
Telephone
63(2)781-9536
Ground Floor, RTC Bldg. QI Compound E. Rodriquez
Sr. Ave. Quezon City
[email protected]
6
Member
Agency/organization
Website
Type
Government
Mailing address
3rd Floor, Bldg. 12 Department of Health San Lazaro
Compound, Sta. Cruz, Manila
Sector Represented
Government
E-mail address
[email protected]
Dr. Ferchito Avelino
CCM member
since
September 2002
Title in agency
Director III
Fax
63(2)743-0512
Role in CCM
Proposal development; Review;
endorsement to CCM; Proposal Review
Panel
Telephone
63(2)743-0512
14
7
Member
Agency/organization
Philippine NGO Council
Website
Type
Non Government Organization
Mailing address
38-A San Luis St. Pasay City, Manila
Sector Represented
E-mail address
[email protected]
Ms. Eden Divinagracia
CCM member
since
March 2004
Title in agency
Executive Director
Fax
63(2)834-5008
Role in CCM
Proposal development; Review Panel;
Telephone
63(2)834-5007
8
Member
Agency/organization
Research Institute for Tropical Medicine
Website
Type
Government
Mailing address
Research Institute for Tropical Medicine FICC
Alabang Muntinlupa City
Sector Represented
Government
E-mail address
[email protected]
Dr. Remigio Olveda
CCM member
since
September 2002
Title in agency
Director
Fax
63(2)842-2245
Role in CCM
Telephone
63(2)807-2628
9
Member
Agency/organization
Tropical Disease Foundation, Inc
Website
Type
Mailing address
Rm 2002 Medical Plaza Bldg. Amorsolo St. cor. Dela
Rosa, Makati City
Sector Represented
E-mail address
[email protected], [email protected]
Dr. Thelma Tupasi
CCM member
since
September 2002
Title in agency
President
Fax
63(2)888-9044
Role in CCM
Proposal development; Proposal Review
Panel
Telephone
63(2)893-6066
10
Member
Agency/organization
World Health Organization – Philippines
Website
Type
International Organization
Mailing address
2nd Floor, Bldg. 9 DOH Compound, Tayuman, Sta.
Cruz, Manila
Sector Represented
E-mail address
[email protected]
Dr. Jean Marc Olivé
CCM member
since
September 2002
Title in agency
Country Representative
Fax
63(2)731-3914
Role in CCM
Proposal Review Panel ; Proposal
development (technical inputs)
Telephone
63(2)528-9761
11
Member
Agency/organization
World Vision Development Foundation, Inc
Website
Type
Mailing address
883 Quezon Avenue Quezon City
Sector Represented
E-mail address
Dr. Melvin Magno
CCM member
since
September 2002
Title in agency
National Health Advisor
Fax
63(2)374-7618
Role in CCM
Telephone
63(2)372-7777
Member
12
15
Agency/organization
United Nations Program on HIV/AIDS
(UNAIDS)
Website
Type
Mailing address
31st Floor RCBC Plaza Ayala Avenue Makati City
Sector Represented
E-mail address
[email protected]
Dr. Ma. Elena Borromeo
CCM member
since
September 2002
Title in agency
Country Coordinator
Fax
63(2)840-0732
Role in CCM
Proposal Review Panel; Proposal
development (technical inputs)
Telephone
63(2)901-0411
13
Member
Type
Department of Interior and Local
Government (DILG)
Government
Mailing address
EDSA cor. Mapagmahal St., Quezon City, MM
Sector Represented
Government
E-mail address
[email protected]
Hon. Austere Panadero
CCM member
since
February 2005
Title in agency
Assistant Secretary
Fax
63(2)925-0361
Role in CCM
Proposal development; Proposal Review
Panel
Telephone
63(2)925-0361
Agency/organization
Website
14
Member
Type
University of the Philippines-College of
Public Health
Government/academe
Mailing address
625 P. Gil St. Ermita, Paco, Manila
Sector Represented
Academic/educational sector
E-mail address
[email protected]
Dr. Caridad Ancheta
CCM member
since
February 2005
Title in agency
Dean
Fax
63(2)524-2703
Role in CCM
Telephone
63(2)521-1394
Agency/organization
Department of Labor and Employment Occupational Safety and Health Center
(DOLE-OSHC)
Website
Type
Government
Mailing address
North Avenue cor. Agham Diliman, Quezon City
Sector Represented
Government
E-mail address
[email protected]
Dr. Dulce Estrella-Gust
CCM member
since
February 2005
Title in agency
Executive Director
Fax
63(2)928-6728
Role in CCM
Telephone
63(2)928-6690
Agency/organization
United Nations International Children
Educational Fund (UNICEF)
Website
Type
Multi/bilateral Development partners
Mailing address
31st Floor, Yuchengco Tower RCBC Plaza 6819
Ayala Avenue, Makati City
Sector Represented
Multi/bilateral Development partners
E-mail address
[email protected]
Dr. Nicholas K. Alipui
CCM member
since
February 2005
Title in agency
Representative
Fax
None
Agency/organization
Website
15
Member
16
Member
16
Role in CCM
Telephone
63(2)901-0170
17
Member
Type
Philippine Council for Health Research and
Development (PCHRD)
Research
Sector Represented
Agency/organization
Website
Mailing address
3rd Flr. DOST Bldg. Taguig, Bicutan, MM
Government
E-mail address
Dr. Jaime Montoya
CCM member
since
September 2002
Title in agency
Executive Director
Fax
63(2)837-2924
Role in CCM
Telephone
63(2)837-2942
Agency/organization
Department of Health – Center for Health
Development – Cordillera Administrative
Region
Website
Type
Health - Regional Level
Mailing address
CHD CAR, Baguio City
Sector Represented
Government
E-mail address
[email protected]
Dr. Myrna C. Cabotaje
CCM member
since
September 2002
Title in agency
Director IV
Fax
63(74)442-8098
Role in CCM
Telephone
63(74)442-8097
18
Member
19
Member
Agency/organization
Provincial Government of Apayao
(Cordillera Administrative Region)
Website
Type
Government
Mailing address
Sector Represented
Local Government
E-mail address
Dr. Thelma Dangao
CCM member
since
September 2002
Title in agency
Provincial Health Officer
Fax
63-78-501-1028
Role in CCM
Telephone
63 -78- 983-1052
Provincial Health Office, Apayao
20
Member
Agency/organization
(NEDA)
Website
Type
Government
Mailing address
12 St. Jose Maria Escriva Drive, Ortigas Center, Pasig
City
Sector Represented
Government
E-mail address
[email protected]
Ms. Arlene Ruiz
CCM member
since
September 2002
Title in agency
Division Chief
Fax
63-2-631-3758
Role in CCM
Telephone
63-2-631-5435
21
Member
Agency/organization
Department of National Defense (DND)
Website
Type
Government
Mailing address
Office for the Undersecretary for Policy, Plans and
Special Concerns
17
Sector Represented
Government
E-mail address
[email protected]
Dr. Peter Galvez
CCM member
since
September 2002
Title in agency
Medical Consultant
Fax
63-2-911-4552
Role in CCM
Telephone
63-2-911-1651
Agency/organization
National Council for Indigenous People
(NCIP)
Website
Type
Government
Mailing address
2nd Flr., De La Merced Bldg., West Avenue cor
Quezon Ave., Quezon City
Sector Represented
Government
E-mail address
[email protected]
Dr. Ricardo Sakai, Jr
CCM member
since
September 2002
Title in agency
Medical Officer V
Fax
63-2-373-9534
Role in CCM
Telephone
63-2-374-5554
22
Member
23
Member
Agency/organization
German Technical Cooperation Agency
(GTZ)
Website
Type
Multi/Bilateral agency
Mailing address
9th Flr., PDCP Bank Bldg., Herrera cor Leviste St.,
Salcedo Village, Makati City
Sector Represented
Multi/Bilateral agency
E-mail address
[email protected]
Dr. Michael Adelhardt
CCM member
since
June 2003
Title in agency
Program Manager
Fax
63-2- 711-6140
Role in CCM
Development; Financial support (technical
writer)
Telephone
63-2-742-3417
24
Member
Agency/organization
European Commission (EC)
Website
Type
Multi/bilateral agency
Mailing address
7th Flr., Salustiana Ty Bldg., Perea St cor Paseo de
Roxas, Makati City
Sector Represented
E-mail address
[email protected]
Dr. Fabrice Sergent
CCM member
since
September 2002
Title in agency
Individual Expert for Health
Fax
63-2-812-6686
Role in CCM
Telephone
63-2-812-6421
Agency/organization
Canadian International Development
Agency (CIDA)
Website
Type
Mailing address
7th Floor, Tower II, RCBC Plaza, Makati City
Sector Represented
E-mail address
[email protected] ,
[email protected]
Ms. Myrna Jarillas
CCM member
since
September 2002
Title in agency
Senior Program Officer
Fax
(63-2) 810-5142
Role in CCM
Telephone
(63-2) 810-5142
Agency/organization
Japan International Cooperation Agency
(JICA)
25
Member
26
Member
Website
18
Type
Mailing address
Ground Floor, Research Institute for Tropical
Medicine, FCC, Alabang, Muntinlupa
Sector Represented
E-mail address
[email protected]
Dr. Mie Kasamatsu
CCM member
since
September 2002
Title in agency
Technical Adviser
Fax
(63-2) 373-9534
Role in CCM
Telephone
(63-2) 772-2088
27
Member
Agency/organization
Samahang Lusog Baga (SLB)
Website
Type
People Living with the Disease
Mailing address
Lung Center of the Philippines, Quezon Avenue,
Quezon City
Sector Represented
Tuberculosis
E-mail address
[email protected]
Mr. Fernando Collera
CCM member
since
November 2005
Title in agency
President
Fax
Role in CCM
Telephone
28
Member
Agency/organization
World Family of Good People Foundation
(WFGP)
Website
Type
NGO
Mailing address
Sector Represented
NGO
E-mail address
[email protected]
Dr. Jocelyn Park
CCM member
since
March 2006
Title in agency
Director
Fax
(63-2) 330-7280
Role in CCM
Telephone
(63-2) 330-7280
Agency/organization
Kasangga Mo Ang Langit (Reyster Langit)
Foundation
Website
Type
NGO
Mailing address
Sector Represented
Malaria
E-mail address
[email protected];
[email protected]
Mr. Rey Langit
CCM member
since
March 2006
Title in agency
Executive Director
Fax
(63-2) 634-5335
Role in CCM
Telephone
(63-2) 634-5335
29
Member
30
Member
Agency/organization
Remedios AIDS Foundation, Inc. (RAF)
Website
Type
NGO
Mailing address
1066 Remedios St., Malate, Manila
Sector Represented
HIV AIDS
E-mail address
[email protected]
Dr. Jose Narciso Melchor Sescon
CCM member
since
March 2006
Title in agency
Executive Director
Fax
(63-2) 524-0494
Role in CCM
development
Telephone
(63-2) 524-0494
31
Member
Agency/organization
Kilusan Ligtas Malaria (KLM)
Website
19
Type
Public private coalition
Mailing address
KLM PRIMM Bldg., PED Cmpd., Brgy. Bancaobancao, Puerto Princesa City
Sector Represented
Public private coalition
E-mail address
[email protected]
Dr. Ray Angluben
CCM member
since
September 2002
Title in agency
Executive Director
Fax
(63-48) 434-5202
Role in CCM
Telephone
(63-48) 434-5202
32
Member
Agency/organization
Couple for Christ – Gawad Kalusugan
Website
Type
Faith Based Organization
Mailing address
Sector Represented
E-mail address
Dr. Elmer Garcia
CCM member
since
March 2006
Title in agency
Director
Fax
(63-2) 522-9231
Role in CCM
Telephone
(63-2) 522-9231
[email protected]
33
Member
Type
Association of Philippine Medical Colleges
(APMC)
Academic Institution
Sector Represented
Academic Institution
E-mail address
Dr. Fernando Sanchez
CCM member
since
March 2006
Title in agency
President
Fax
(63-2) 4153488
Role in CCM
Telephone
(63-2) 3727947
Agency/organization
Website
Mailing address
[email protected]
34
Member
Agency/organization
Philippine College of Chest Physician
(PCCP)
Website
Type
Private Corporation/Professional
Organization
Mailing address
Sector Represented
Private Corporation/Professional
Organization
E-mail address
[email protected]
Dr. Renato B. Dantes
CCM member
since
March 2006
Title in agency
President
Fax
9240144
Role in CCM
Telephone
9249204
84-A Malakas St.
Piñahan Rd. QC
35
Member
Agency/organization
The Salvation Army
Website
Type
Private Organization/Faith Based
Mailing address
Sector Represented
E-mail address
Mr. Charles Malcom Induruwage
CCM member
since
Title in agency
President
Fax
Role in CCM
Telephone
[email protected]
November 2005
20
3B.1.3 National/Sub-national/Regional (C)CM endorsement of proposal
Coordinating Mechanism members must endorse the proposal. Limited exceptions are described in the Guidelines for
Proposals in section 3B.1.3. Please note that the original (not photocopied, scanned or faxed) signatures of the CCM
members should be provided in table 3B.1.3. The minutes of the CCM meetings at which the proposal was developed and
endorsed must be attached as an annex to this proposal. The entire proposal, including the signature page and minutes, must
be received by the Global Fund Secretariat before the deadline for submitting proposals.
Applicant name
Country/countries
Philippines
“Each of the undersigned, hereby certify that s/he has reviewed the final proposal and supports it.”
Table 3B.1.3 – National/sub-national/regional (C)CM endorsement of proposal
Agency/organization
Title
Department of Health – Health
Program Development Cluster
(DOH)
Ethelyn Nieto, MD, MPH,
MHA, CESO III
Undersecretary
of Health, DOH –
CHAIR CCM
United States Aid for International
Development (USAID)
Aye Aye Thwin, MD
Chief, OPHN –
Vice Chair CCM
World Health Organization Philippines (WHO)
Jean Marc Olivé, MD
WHO
Representative
United Nations Program on HIV
and AIDS (UNAIDS)
Ma. Elena Borromeo,
MD, MPH
Country
Coordinator
Positive Action Foundation Phil,
Inc (PAFPI)
Joshua Formentera
President
(PNAC)
Irene Fonacier
PNAC
Representative
Phil. NGO Council for Health and
Welfare, Inc (PNGOC)
Eden Divinagracia, PhD
Executive
Director
Pilipinas Shell Foundation, Inc
(PSFI)
Marvie Trudeau
Program
Manager
Research Institute for Tropical
Medicine (RITM)
Remigio Olveda, MD,
MPH
Director IV
Tropical Disease Foundation, Inc.
(TDFI)
Thelma Tupasi, MD
President
Department of Interior and Local
Government (DILG)
Austere Panadero
Assistant
Secretary
College of Public Health,
University of the Phil. (UP CPH)
Caridad Ancheta, PhD
Dean
Department of Labor and
Employment (DOLE)
Dulce Estrella Gust, MD,
MPH
Executive
Director
United Nations International
Children’s Education Fund
(UNICEF)
Nikolas Alipui
Representative
Date
(yyyy/mm/dd)
Signature
21
Phil. Council for Health Research
and Development (PCHRD)
Jaime Montoya, MD
Executive
Director
DOH Center for Health
Development in Cordillera
Autonomous Region (DOH CAR)
Myrna Cabotaje, MD,
MPH
Director IV
Local Government Untit – Apayao
Province
Thelma Dangao, MD
Provincial Health
Officer
National Economic Development
Authority (NEDA)
Arlene Ruiz, MPH
Division Chief
Department of National Defense
(DND)
Peter Galvez, MD
Medical
Consultant
National Commission on
Indigenous People (NCIP)
Ricardo Sakai Jr., MD
Medical Officer V
Salvation Army
Mr. Charles Malcom
Induruwage
President
Couples for Christ - Gawad
Kalusugan
Elmer Garcia, MD
Director
German Technical Cooperation
Agency (GTZ)
Michael Adelhardt, MD
Program
Manager.
European Commission (EC
Fabrice Sergent, PhD
Individual Expert
for Health
Canadian International
Development Agency (CIDA)
Myrna Jarillas
Senior Program
Officer
Japan International Cooperation
Agency (JICA)
Mie Kasamatsu, MD
Chief Advisor
Association of Philippine Medical
Colleges (APMC)
Fernando Sanchez, MD
President
World Family of Good People
Foundation, Inc (WFGP, Inc.)
Jocelyn Park, MD
President
Kasangga Mo Ang Langit (Reyster
Langit) Foundation, Inc
Rey Langit
President
Remedios AIDS Foundation, Inc
(RAF)
Jose Narciso Melchor
Sescon, MD
Executive
Director
Kilusan Ligtas Malaria (KLM)
Ray Angluben
Project Director
Philippine Coalition Against
Tuberculosis (Phil CAT)
Jubert Benedicto, MD
Chairperson
Philippine College of Chest
Physician (PCCP)
Renato Dantes, MD
President
Samahang Lusog Baga (SLB)
Fernando Collera
President
World Vision Development
Foundation (WVDF)
Melvin Magno, MD
National Health
Advisor
22
The table below provides a list of the various annexes that should be attached to the proposal. Please complete this
checklist to ensure that everything has been included. Please also indicate the applicable annex numbers on the right
hand side of the table.
Relevant item on the
Proposal Form
Description of the information required in the
Annex
Name/Number given to
annex in application
Section 2: Eligibility
Coordinating Mechanisms only:
2.2.1 b)
Comprehensive documentation on processes used to
select non-governmental sector representatives of the
Coordinating Mechanism.
2.2.2
Documented procedures for the management of
potential Conflicts of Interest between the Principal
Recipient(s) and the Chair or Vice Chair of the
Coordinating Mechanism.
First Philippine Partner’s
Meeting (Annex 2)
CCM Election Guidelines
(Annex 3)
First Philippine Partner’s
Meeting (Annex 2)
Minutes of the July 18
CCM Meeting (Annex 4)
Documentation describing the transparent processes
to:
2.2.3 a
- solicit submissions for possible integration into the
proposal.
Publication for ‘Call for
Concept’ for Round 6
(Annex 7)
PNAC meeting
proceedings (Annex 9)
2.2.3 b
- review submissions for possible integration into the
proposal.
2.2.3 c
- select and nominate the Principal Recipient (such as
the minutes of the CCM meeting at which the PR(s)
was/were nominated).
2.2.3 d
- ensure the input of a broad range of stakeholders in
the proposal development process and grant oversight
process.
Minutes of July 18
meeting (Annex 4)
Minutes of June CCM
Meeting (Annex 6)
Minutes of the July CCM
Meeting (Annex 4)
Proposal Development
Process (Annex 10)
Department Personnel
Order Creating the TWG
for Round 6 (Annex 8)
Section 3A: Applicant Type
Coordinating Mechanisms:
3A.2.1,
3A.3.1
or 3A.4.1
Documents that describe how the national/sub-national
or regional Coordinating Mechanism operates (TOR,
statutes, by-laws or other governance documentation
and a diagram setting out the interrelationships
between all key actors)
CCM Organizational
Structure and
Memberships (Annex 1)
23
Relevant item on the
Proposal Form
Description of the information required in the
Annex
Name/Number given to
annex in application
Regional Organizations:
3A.5.1
Documents that describe the organization such as
statutes, by-laws (official registration papers) and a
summary of the main sources and amounts of funding.
Non-CCM Applicants:
3A.6
Documentation describing the organization such as
statutes and by-laws (official registration papers) or
other governance documents, documents evidencing
the key governance arrangements of the organization,
a summary of the organization, including background
and history, scope of work, past and current activities,
and a summary of the main sources and amounts of
funding.
3A.6.2 b
Documentary evidence of any attempts to include the
proposal in the relevant CCM’s final approved country
proposal and any response from the CCM.
3A.6.3
(if from country where
no CCM exists)
Provide evidence from relevant national authorities that
the proposal is consistent with national policies and
strategies.
Section 3B: Proposal Endorsement
3B.1.3
(Coordinating
Mechanisms)
Minutes of the meeting at which the proposal was
developed and endorsed. For Sub-CCMs and RCMs,
documented evidence that national CCM(s) have
agreed to proposal.
Minutes of May CCM
Meeting (Annex 5)
Minutes of June CCM
Meeting (Annex 6)
Minutes of July CCM
Meeting (Annex 4)
3B.2.2
(Regional
Organization)
Documented evidence that the national CCMs have
agreed to proposal.
Minutes of the July CCM
meeting (Annex 4)
Other documents relevant to sections 1-3 attached by applicant:
24
4 Component Section HIV/AIDS
PLEASE NOTE THAT THIS SECTION AND THE NEXT MUST BE COMPLETED FOR EACH COMPONENT. Thus, for
example, if the proposal targets three components, sections 4 and 5 must be completed three times.
For more information on the requirements of this section, please refer to the Guidelines for Proposals, section 4.
4.1 Indicate the estimated start time and duration of the component
Please take note of the timing of proposal approval by the Board of the Global Fund (described on the cover page
of the Proposal Form). The aim is to sign all grants and commence disbursement of funds within six months of
Board approval. Approved proposals must be signed and have a start date within 12 months of Board approval.
Table 4.1.1 – Proposal start time and duration
From (yyyy/mm)
To (yyyy/mm)
2007/07
2012/06
Month and year:
4.2 Contact persons for questions regarding this component
Please provide full contact details for two persons; this is necessary to ensure fast and responsive
communication. These persons need to be readily accessible for technical or administrative clarification purposes,
for a time period of approximately six months after the submission of the proposal.
Table 4.2 – Component contact persons
Primary contact
Secondary contact
Name
Dr. Jose Gerard Belimac
Dr. Aura Corpuz
Title
Program Manager
Medical Specialist III
Organization
Infectious Disease Office
National Epidemiology Center
Mailing address
Bldg 13, DOH Compound, Rizal
Avenue, Sta. Cruz, Manila
Bldg. 9, DOH Compound, Rizal
Avenue, Sta Cruz, Manila
Telephone
63 2 7116808
63 2 743 8301 local 1907
Fax
63 2 7116808
63 2 743 8301 local 1907
E-mail address
[email protected]
[email protected]
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4.3 Component executive summary
4.3.1 Executive summary
Describe the overall strategy of the proposal component, by referring to the goals, objectives and main
activities, including expected results and associated timeframes. Specify the beneficiaries and expected benefits
(including
target
populations
and
their
estimated
number).
(Please include quantitative information where possible. Maximum of one page.)
The proposal focuses on three areas of HIV intervention: prevention, treatment, care and support for the
people living with HIV/AIDS (PLWHA); and, supportive environment. Goal 1 is maintaining a less than 1%
HIV prevalence by scaling up Voluntary Counseling and Testing (VCT) and ensuring safe blood supply.
Goal 2 is reducing the impact of HIV/AIDS among the PLWHAs, their families and significant others by
scaling up treatment, care and support and strengthening health system to provide HIV/AIDS services.
The proposal highlights the critical role of VCT in preventing further spread of HIV and in providing
comprehensive treatment, care and support services thru linkages. VCT services will be accessed by the
most at risk population (MARP) and the general population while blood donors through a strengthened
self-deferral mechanism will access the same. This will be implemented in 23 project sites where 29% of
the country’s MARP and 34% of the adult general public will benefit.
The target groups of the proposal will be clients of Social Hygiene Clinics (SHC) and private STI clinics,
migrant workers, pregnant HIV positive women and blood donors. Behavior Change Communication
(BCC), diagnosis and treatment of Sexually Transmitted Infections (STI) and VCT services will be
provided. By the end of the fifth year there will be 14,230 VCT services, 320 migrant workers and/or their
families trained as advocates and 3,200 peers reached, 25 HIV positive mothers enrolled in PMTCT
program, 1,380 volunteer blood donors pooled and 400,000 blood units (which is 10% of the estimated
country need) tested for HIV and other transfusion-transmissible infections (TTIs) to ensure safe blood
supply.
Other strategies are mass media and public education focusing on healthy lifestyle and HIV/AIDS
prevention. Likewise, surveillance and information system will be strengthened. There will be capacity
building of health providers and upgrading of health facilities in all levels of health system.
Activities addressing treatment, care and support for PLWHAs include provision of ARV (200 PLWHAs),
prophylaxis and treatment of opportunistic infections (500 PLWHAs in need of treatment), vaccines
against influenza, pneumocci and varicella (170 PLWHAs), and multivitamins for children. To cater for the
increasing number of PLWHAs needing clinical care, 2 additional treatment centers will be established.
Debriefing activities to care for carers will be conducted.
There will also be multi-sectoral community based forums to reduce stigma. A national convention to
empower PLWHAs will be conducted. One hundred PLWHAs will be engaged in microentrepreneural
activities for sustainable financial independence. Furthermore, 200 will be enrolled in the national health
insurance program. ARV and VCT social marketing will be implemented.
With the country’s response generating positive impact in reaching the most at risk through the two
previous Global Fund grant (Round 3 and 5), the demand for VCT and other health care related HIV
services such as blood service is becoming more imminent. The proposal, which totals to US$18,334,590
will jumpstart the VCT and blood safety in key cities nationwide.
4.3.2 Synergies
If the proposal covers more than one component, describe any synergies expected from the
combination of different components—for example, TB/HIV collaborative activities.
(By synergies, we mean the added value that the different components bring to each other, or how the
combination of these components may have broader impact.)
The HIV/AIDS component covers scaling up of VCT and blood safety as a means of preventing
transmission of HIV among the most at risk and other vulnerable population and treatment, care and
support for PLWHAs. Health care system strengthening will involve the blood services facilities, Social
26
Hygiene Clinics and hospitals. Malaria screening (diagnosis) among blood donors is among the
transfusion transmissible infections included in the Project. Appropriate referral will be made to the
malaria control program services.
On TB/HIV collaboration, VCT services in the Social Hygiene clinics and selected treatment centers will
provide the linkage to the TB DOTS centers at the village level. TB resistant cases with history of high risk
sexual practices or exposures can be referred to VCT services in the same clinic. Likewise, HIV/AIDS
cases with TB as opportunistic infection can better access services from the clinics once referral system
has been established between clinics and treatment centers.
4.4 National program context for this component
The information below helps reviewers understand the disease context, and which problems the proposal will
address. Therefore, historical, current and projected data on the epidemiological situation, disease-control
strategies and broader development frameworks need to be clearly documented. Please refer to the Guidelines
for Proposals, section 4.4.
4.4.1 Indicate whether you have any of the following documents (tick appropriate box), and if so,
please attach them as an annex to the Proposal Form:
National Disease Specific Strategic Plan
National Disease Specific Budget or Costing
National Monitoring and Evaluation Plan
Other document relevant to the national disease program context (e.g. the latest disease
surveillance report)
Please specify:
Annex 12: National HIV Estimates of 2005
Annex 13: Integrated HIV and Behavioral Surveillance System Technical Report (2005)
Annex 14: Study of Confirmed HIV Positive Blood Donors and Evaluation of the National Voluntary
Blood Services Program)
4.4.2 Epidemiological and disease-specific background
Describe, and provide the latest data on, the stage and type of epidemic and its dynamics (including
breakdown by age, gender, population group and geographical location, wherever possible), the
most affected population groups, and data on drug resistance, where relevant. With respect to
malaria components, also include a map detailing the geographical distribution of the malaria
problem and corresponding control measures already approved and in use. Information on drug
resistance is of specific relevance if the proposal includes anti-malarial drugs or insecticides. In the
case of TB components, indicate, in addition, the treatment regimes in use or to be used and the
reasons for their use.
As of June 2006, the National HIV/AIDS Registry of the Department of Health, has recorded a total of
2,566 HIV-antibody seropositive cases of which 72% are asymptomatic and 28% are AIDS cases. From
1993 to 2003, more than a hundred HIV cases are recorded annually (10-15 cases per month). However,
in 2004 and 2005, the annual cases doubled up to 200. This year, cases are noted to be increasing by
more than 30 cases per month since April. Majority (64%) were males and 67% were in the 20-39 year
age group. Modes of transmission are sexual intercourse (87%), perinatal (1.4%), blood transfusion
(0.7%), needle prick (0.1%) while the remaining 11% has no reported mode of transmission. Profile
showed varied occupations ranging from students, housewives, employees, businessmen and health
workers. Significant proportion (35%) are migrant workers coming from the 8 million Filipinos working
outside the country, working as sea farers (34%), domestic helpers (17%), employees (9%), entertainers
(7%), health professionals (6%). Increasingly, cases of peri-natal and pediatric HIV have been reported in
27
selected areas of the country at 1.5% (as of May 2006) and with 4 cases in the last 6 months. Reports of
HIV positives are distributed throughout the 16 regions of the country. Metro Manila accounts for a bigger
number of reported HIV as this is where the bigger health facilities are located.
Based on the DOH national estimates done in December 2005, around seventy four percent of the
estimated cases are from the general population (8,226 out of the 11,186). The estimation process used
is based on the Workbook Model by WHO/UNAIDS and the data used for the general population is
based on the blood donor data. Increasing trend of HIV prevalence (4/100,000: 2000; 3/100,000: 2001;
2/100,000: 2002; 6/100,000: 2003; 8/100,000: 2004) among blood donors are reported by the National
Epidemiology Center (DOH) in 2005. Considering the sequential testing being done for blood units (blood
units are only tested for HIV once it has been tested negative for Hepatitis B and syphilis), the prevalence
could be higher as between 5-8% of the blood units was not tested for HIV antibody.
Also in 2005, the NEC conducted a study on confirmed HIV positive blood donors and evaluation of the
National Blood Services Program showing the proliferation of hidden paid replacement donors, a weak
pre and post donation counseling, weak self-deferrals, the absence of VCT as entry points to HIV/AIDS
prevention and to referral for treatment, care and support for those who self-defer, the lack of emphasis
on HIV/prevention in the IEC materials, the vague link between safe blood supply as a major prevention
strategy to prevent HIV/AIDS. All these are tantamount to a probable spread of HIV/AIDS if no measures
will be instituted to safeguard safe supply of blood in the country. Just recently, the Supreme Court
decided to close down commercial blood banks and the total shift to a more voluntary donation system. In
its part, the Department of Health through the Philippine Blood Center is building up a centralized system
for blood processing, testing and distribution since 2005.
The present situation calls for immediate response as there are indications that the country’s blood supply
is at risk for HIV and other transfusion transmissible infections (TTIs): (1) sixty five percent of blood used
in hospitals came from family replacement donors who may have infiltrated by ‘hidden paid donors’; (2)
each year around 75,000 blood units are being supplied by commercial blood banks where paid
donations occur; and (3) weak interaction between the National AIDS/STD Prevention and Control
Program (NASPCP) and the National Voluntary Blood Services Program (NVBSP) including pre and post
donation counseling.
In the 2005 IHBSS, it is clearly shown how population overlaps. One example is a scenario in Cebu
where an IDU has a sexual relationship with a wife/husband/girlfriend/boyfriend. There is also a scenario
where a MARP (FSW or MSM) has a regular sexual partner who could be a
wife/husband/girlfriend/boyfriend. In most of these sexual relationships, condoms are not being used.
Based on the National Demographic Health Survey in 2003, condom use is low at only 6% of the
population.
The knowledge on the size of population at risk is also important to gauge the spread of HIV/AIDS. Based
on the 2005 HIV Estimates, the population of MARP are as follows: MSM: 379,799-804,280; Male clients
of sex workers: 280,604-438,444; female sex workers: 112,354-175,553; IDU: 16,000-30,500 and general
population: 42,900,775-43,688,643. Thus, the number of HIV positive and their respective prevalence
using the 2005 sero-surveillance results are noted to be: PLWHAs (15-49 years old) : 11,168 (0.03%:
adult prevalence) and this figure is broken down into: MSM 1,171 (0.00-0.39%); male clients of sex
workers 1,136 (0.00-0.63%); FSW 286 (0.06-0.34%); IDU 349 (0.10-2.90%) and general population 8,226
(0.01-0.03). Further analysis shows that there is wide disparity between the number of cases in the
National HIV/AIDS Registry and the 2005 HIV Estimates. The national aggregate of HIV prevalence in the
country (conducted in ten sentinel sites and among MARP) may remain less than 1% (FSW: 0.2%, male
clients of STD clinics: 0.1% and injecting drug users 0.8%) since 1993, however, STI remains high.
Surveys conducted by the Family Health International (FHI) among MSM in 2004 showed high
prevalence of both rectal (18%) and urethral (11%) Chlamydia and gonococcal (6%) infections. Female
sex workers in a special survey in selected areas have an STI prevalence of 44%. The 2005 IHBSS
reported an 81% hepatitis C prevalence among IDUs in 1 city.
The number of PLWHAs on anti retro-viral therapy has gone up to 140 PLWHAs because of GFATM
supported national treatment program since 2005. Six treatment centers have been fully trained and
equipped in Metro Manila, Northern Luzon, Central Visayas and Mindanao
28
4.4.3 Disease-control initiatives and broader development frameworks
Proposals to the Global Fund should be developed based on a comprehensive review of disease-specific
national strategies and plans, and broader development frameworks. This context should help determine how
successful programs can be scaled up to achieve impact against the three diseases. Please refer to the
Guidelines for Proposals, section 4.4.3.
a) Describe comprehensively the current disease-control strategies and programs aimed at the
target disease, including all relevant goals and objectives with regard to addressing the disease.
(Include all donor-financed programs currently implemented or planned by all stakeholders and
existing and planned commitments to major international initiatives and partnerships.)
The Medium Term Philippine Development Plan 2005-2010 (MTPDP) is the country’s development
agenda anchored in the attainment of the Millennium Development Goals. The goals of the MTPDP by
2010 include (1) maintaining a less than 1% prevalence of HIV/AIDS in the most at risk population and (2)
maintaining a less than 1% prevalence of HIV/AIDS in the general population. More specific HIV/AIDS
and STI goals, objectives and targets are embodied in the Fourth AIDS Medium Term Plan (AMTP4)
2005-2010 and the National Objectives for Health (NOH) 2005-2010.
The Fourth AIDS Medium Term Plan (2005-2010) of the Philippine National AIDS Council specifies the
concrete actions on how to maintain the low prevalence of HIV infection in the country. Guided by the
Republic Act 8504 of 1998, the country’s comprehensive response was able to institutionalize HIV and
AIDS programs in different national agencies and few local governments. The National AIDS STD
Prevention and Control Program (NASPCP), under the Department of Health provides the guidance and
technical supervision for the implementation of health sector response to HIV and AIDS.
PREVENTION:
The goal for 2010 under the National Objectives for Health is to reduce by half the prevalence of STI
(baseline is 23% in 2002) and increase condom use to 80% among the most at risk population. Known
effective intervention such as 100% Condom Use Program is presently being implemented in WHO (6)
and Global Fund (26) sites. Advocacy to local governments to include 100% CUP in its local ordinance or
to the Local AIDS Council activities is one of the primary activities of the NASPCP and PNAC. One of the
effective strategies developed in HIV/AIDS prevention in the Philippines is the outreach services,
especially, that the target clienteles are the hard-to-reach group in the community. Trust and confidence
should be built between the target clienteles and the service providers. For more than two decades now,
the partnership between the government, non-government organizations including organization of
PLWHAs, people’s organizations and the private sector has been very effective.
Sensitive matters like harm reduction for injecting drug users, condom use for people in prostitution, peer
counseling and information dissemination in cruising areas are handled professionally by the NGO
partners.
HIV in the workplace program of the Labor Department has been in existence and is being implemented
by the Occupational Safety and Health Center. HIV/AIDS education in schools has not made a big dent
as full scale training of teachers are yet to be realized, except for the integration of HIV/AIDS to the
curriculum for elementary and high school students. Youth focused intervention is limited to integrated
education campaigns with all other lifestyle related illnesses.
International organizations and bilateral partners also support the national and local response in
prevention and care including implementation of packages of STI and HIV services. UNFPA is currently
implementing community support and information on HIV/AIDS in 10 poorest provinces in the Philippines;
USAID through the LEAD for Health project has also provided preventive education, surveillance
assistance and advocacy to local government units. For the past two years, FHI, one of the implementers
of the LEAD project conducted a research study among MSM with the goal of providing the National
HIV/AIDS program baseline data for planning specific interventions in the future. UNICEF is supporting
activities relating to the vulnerability of children and youth including HIV AIDS prevention. The WHO has
continuously been providing technical as well as financial assistance to the Department of Health in all
29
aspects of prevention, development of guidelines, and resource materials for policy directions in program
implementation.
Voluntary Counseling and Testing
While there are over 800,000 HIV testing carried out in 2005 from over 500 accredited public and private
HIV Testing Laboratories nationwide, these are not considered a true VCT as there are very limited pre
and post test counseling services among the testing laboratories. Even the highly-urbanized cities have
no VCT services in place. VCT capacity has just been recently introduced under Global Fund Project
sites which will total to 26 sites with the additional sites under the Round 5 approved proposal. These
sites are trained using the WHO VCT Modules. The NASPCP Regional Coordinators are likewise
trained under the Global Fund Round 3 to provide technical assistance and support to the local
government units implementing a VCT strategy. UNICEF on its part is piloting a VCT strategy in 4 of its
10 project sites this year.
Because of weak VCT, surveillance rounds have been used by some local governments as a tool for
case finding. In some instances in the past, people at higher risk of HIV are using the blood donation
services in order to know their serological status (if not notified or contacted by the blood bank then they
presumed an HIV negative result). Findings from the 2006 assessment of HIV testing in the country by
FHI recommends implementation of VCT in each of the Social Hygiene Clinics to cover for the most at
risk population, revision of donor screening tools (questionnaire), improvement in the system of HIV
testing including addressing the delay in the release of HIV test results.
At present the Bureau of Health Facilities and Services (BHFS), the licensing arm of the DOH, in its effort
to support the National HIV/AIDS Program, issued an Administrative Order in 2005, requiring all
accredited HIV testing centers to integrate VCT in their services. The National Epidemiology Center, with
support from WHO and UNICEF, through its National HIV/AIDS Registry, is currently pilot testing its
newly developed protocol in submitting reports of confirmed HIV positives. An important part of the
protocol is the provision of pre and post test counseling and referral to HACT (HIV/AIDS Core Team) for
proper assessment.
STI Diagnosis and Treatment
Under the leadership of the National AIDS STD Prevention and Control Program, the Philippines is
implementing a special STI clinic approach through the Social Hygiene Clinics (SHC). The SHC is
managed by the city health officers in each cities or municipalities and has devoted health personnel
(doctors, nurses and midwife) for screening, counseling and treatment of STI. The SHC issues health
certificates to people working in entertainment establishments including female sex workers. In 2003, with
the establishment of Sentinel STI Etiologic Surveillance System (SSESS), thirteen social hygiene clinics
in the previous ASEP sites were equipped with the capacity to diagnose STI based on standard case
definition. The SHC service extends not only to the female sex workers but also to a limited extent to the
other risk groups namely: MSM, Male clients of Sex workers, male commercial sex workers, as well as to
the other vulnerable groups like housewives and children. In some areas, SHC has been renamed as
reproductive health and RTI clinics to expanded services and to lessen the stigma and discrimination
attached with the SHC.
Only few local government units procure medicines and supplies for the control of STI in their respective
localities while a greater majority do not adequately provide medicines for STI resulting to increased
drug resistance as a result of non-compliance to expensive STI drugs.. Etiological diagnosis is used in
areas where laboratory services are available (cities) but in more remote areas syndromic system is still
being used at the rural health clinics.
Blood Safety and Universal Precautions
The promulgation of Republic Act 7719 or the National Blood Services Act of 1994 promotes safe,
adequate and efficient blood banking and transfusion practices in the country. The National Voluntary
Blood Services Program (NVBSP) has been mandated to implement activities for the promotion of
voluntary blood donation, adequate supply of safe blood through testing and rational use of blood.
NVBSP upholds the concept of a good manufacturing practice (GMP) which simply states that the quality
of blood product is determined by the quality of source and the manufacturing process. The program
emphasizes the need for a voluntary non-remunerated blood donors from low risk areas as foundation of
safe and adequate blood supply. Good laboratory practice is observed in testing blood units for
30
transfusion. Guided by the prevalence of disease, sequential testing is being implemented in the blood
service facilities (after filling out the donor interview data sheet, followed by donor screening and if being
found healthy for donation, the donor will be bled and blood unit is tested for hepatitis B. If blood unit is
found negative for hepatitis B, it will be tested for malaria, then syphilis and only blood unit found negative
for the three diseases will be tested for antibodies to HIV 1 and 2 and finally hepatitis C virus (Manual of
Standards for Blood Banks and Blood Centers in the Philippines).
In 2005, the National Voluntary Blood Service Program started undergoing major changes: an
administrative order creating a nationally coordinated network of blood service facilities was issued. This
aims to increase the effectiveness and efficiency of blood service facilities through centralized testing and
blood component processing as well as improved blood collection and distribution systems. Also, ELISA
will be used for testing the blood units for HIV. The rationale for centralization was based upon the global
strategy advocated by WHO to provide adequate supply of safe blood.
Advocacy and Implementation of Philippine AIDS Law
Advocacy efforts aimed at the media are significant. Training/orientation are given to members of various
associations of media practitioners, resulting to a more sensitive and responsible reporting about
HIV/AIDS, observing confidentiality and respecting human rights , as well as contributing to the
reduction of stigma and discrimination. The World AIDS Day and the AIDS Candlelight Memorial have
also drawn attention and awareness to HIV/AIDS and the various facets of the disease. To reach the
youth (identified as one of the highly vulnerable groups), HIV/AIDS NGOs, the government, media,
private sector, and international organizations (UNICEF, UNFPA, UNDP and WHO through the UN
Theme Group on HIV/AIDS) worked together to sponsor an MTV special concert with popular bands and
singers which was done in 2003 and 2004. This has drawn a crowd of about 60,000 young people in
2003 and at least 40,000 in 2004. UNAIDS is supporting a project aimed at mobilizing and engaging more
leaders (political leaders, media, business leader, faith-based organizations) to mount and accelerate
HIV/AIDS response in the country. UNDP is likewise supporting a project on Leadership and HIVAIDS
with particular focus on local leaders.
UNICEF will be working at the local level to strengthen the local policy environment with particular focus
on issues affecting children and youth and to build the capacity of health care providers to address youth
concerns and to empower vulnerable youth and women.
Advocacy for the implementation of the HIV/AIDS Law and reduction of stigma and discrimination to
PLWHAs need to be further strengthened. As numerous national and local concerns take away attention
from HIV/AIDS, there is an even greater need to advocate for local funding for HIV/AIDS prevention,
sustainability of NGOs working with HIV/AIDS, and government assistance for care, support and
treatment especially ARVs and treatment for OIs.
Training
Training initiatives are limited due to inadequate financial resources. In particular, manuals are not
produced in adequate quantities and dissemination through training has been highly selective. One of the
major challenges being faced in capacity building is increased out migration of experienced health
workers for a higher salary leaving the novice to carry on the task. The challenge is on how the health
workers could be encouraged to remain and serve the Philippine health sector.
TREATMENT, CARE AND SUPPORT
The Global Fund Round 3 developed a network of six hospitals as referral centers for all HIV/AIDS
related health services distributed across the Philippine archipelago. However, with only six hospitals,
gaps exist in terms of its coverage. Also, part of the Global Fund package is care and support services
provided by a minimal number of NGOs only. Currently, ARV is being provided under the national ARV
program with support from the Global Fund. DOH procured US$16,000 second line ARV while GFATM
procured first line ARV. The present program has already enrolled 130 PLWHAs. The HIV/AIDS
Component of Round 5 which will be implemented this year will include development of another treatment
center in Bicol Region to cover patients from the southern portion of the Luzon Island. While treatment
centers are expanding, the diagnostic and laboratory treatment monitoring such as CD4 count and viral
load is limited in Metro Manila particularly the Research Institute for Tropical Medicine and San Lazaro
Hospital. Routine laboratory testing for toxicity monitoring has been offered free by the DOH retained
hospitals as part of support to PLWHAs under ART.
31
Other significant work includes the development of HIV/AIDS clinical management guidelines for
hospitals, the establishment of HIV/AIDS Core Teams (HACTs) in 56 DOH-retained hospitals and about
40 provincial hospitals, incorporation of ARVs into the National Drugs Formulary and addressing the need
for a national agency like the DOH to procure ARVs considering patent issues and TRIPS. Furthermore,
there was a development of Care and Support Manual for Social Workers, and training of 103 social
workers for community-based care and support. But given the increased migration of health workers in
the country for higher salaries in industrialized countries, those who were trained as HACT personnel
since 1996 has already left the country. The National Program has to continuously provide training for
HACT members because of out migration of health workers.
The National Reference Laboratories:
STD/AIDS Central Cooperative Laboratory (SACCL) of the DOH confirms all reactive blood samples
referred from hospitals, clinics and laboratories. Confirmed HIV positive are reported to NEC for
recording. Likewise, Research Institute for Tropical Medicine (RITM) confirms all reactive blood units
referred from all blood service facilities. Confirmed HIV positive blood units will be reported to NEC for
recording. Funding of HIV surveillance activities for SACCL is provided by the National AIDS/STI
Prevention and Control Program (NASPCP) and NEC. On the other hand, confirmatory tests for blood
units are being funded by the National Voluntary Blood Services Program (NVBSP).
LOCAL RESPONSE
Eighteen (18) Local AIDS Councils have been set up but not all of them receive budget allocations from
their local governments for their operations. Local governments have the human resources and the
structure to implement interventions and all that is needed is for the national program to provide guidance
and capacity building in some areas. Almost all cities in the Philippines have social hygiene clinics where
STIs can be detected and treated. Public regional, provincial and city hospitals take care of treatment
while municipal health centres serve as primary health care stations.
SURVEILLANCE AND RESEARCH
The Philippines is one of the first countries which established its HIV/AIDS surveillance system. Serologic
surveillance provided an early warning system to the epidemic and behavioral surveillance provided the
National program knowledge on behaviors that put the population at risk for HIV. With the evolution of the
surveillance system in almost all neighboring Asian countries, the Philippines in 2005 adopted the new
methodologies of the Integrated HIV Behavioral and Serologic Surveillance. This has provided the
country robust information on the real magnitude of infection. The advent of 2005 also saw the need for
estimating the number of risk populations to better understand the scope of probable transmission in the
area. This was done in the ten previous ASEP sites through the funding of USAID with technical
assistance from the Family Health International. Since surveillance is limited to ten sentinel sites, the
effects of migration, urbanization and mass media may have changed the mapping done more than five
years ago. It is timely to conduct an assessment of the sites outside the ten sentinel sites to be able to
determine if expansion is already needed at this point in time.
The Sentinel STI Etiologic Surveillance System (SSESS) is another leap for the country to monitor STI
trend and correlate with behavioral surveillance and HIV serologic surveillance results (second generation
surveillance). In low level HIV epidemic country, STI trend is an important surrogate for HIV infection.
SSESS was established in 13 sites in the country with expansion to 11 sites during the round 3 GFATM
on HIV/AIDS. In 1987, the National HIV/AIDS Registry was established in the DOH, despite its limitations,
information gathered from hospitals, clinics, laboratories were used by program managers to plan their
prevention efforts and lobby for both local and international funding. The National HIV/AIDS Registry was
the system that detected the double reporting especially among blood donors. In contrast to the active
surveillance focused on the MARP, the registry records the HIV positive in the general population,
including that of the migrant workers. With the new protocol being implemented to strengthen the
reporting system, the system aims to explore the possibility of tracking ARV utilization and need and
PMTCT. With the implementation of the Integrated Blood Bank Information System, linkage with the
National HIV/AIDS Registry will be established to enhance tracing of double reporting and blocking off
paid donors.
MONITORING AND EVALUATION
The Department of Health as well as the other government and non-government agencies have their
monitoring plan inherent in their system. For the government agencies, limited resources prevented them
32
from conducting this activity regularly. NGOs and other multilateral/bilateral agencies also have their own
system of monitoring. Several studies are being conducted in the Philippines, yet the Department of
Health, with its AIDSWATCH and the Philippine National AIDS Council (PNAC) do not have documents to
be able to have an actual assessment of the country’s response to HIV/AIDS. To comply with the “three
ones” initiative of UNAIDS, the National Monitoring and Evaluation plan for HIV/AIDS is being finalized
and the data collection process is currently being pilot tested. The use and training for CRIS (Country
Response Information System) which is the tool for HIV/AIDS’ data collection is on its way to
implementation in the GF sites.
b) Describe the role of HIV/AIDS-, tuberculosis- and/or malaria-control efforts in broader
developmental frameworks such as Poverty Reduction Strategies, the Highly-Indebted Poor
Country (HIPC) Initiative, the Millennium Development Goals or Sector-Wide Approaches.
Outline any links to international initiatives such as the WHO/UNAIDS ‘Universal Access
Initiative’ or the Global Plan to Stop TB or the Roll Back Malaria Initiative.
The Medium Term Philippine Development Plan 2005-2010 outlines the country’s development objectives
anchored in the attainment of Millennium Development Goals by 2015. The National Objectives for Health
and the Fourth AIDS Medium Term Plan distinctly outlines the important strategies to reduce HIV
transmission in the most at risk and the general population.
Universal access to HIV prevention, treatment, care and support is a Philippine commitment. It draws up
the roadmap to achieve its goals and objectives, which is set by the country through a multi-sectoral
approach. The country defines UA as:
(1) Optimal availability and utilization of comprehensive prevention, treatment, care and support
information, services and commodities by most-at-risk and vulnerable populations, people living with
HIV/AIDS and their affected families and communities, and the general public.
(2) Provision of equitable and sustainable information, services and commodities to all those who need
them (most-at-risk and vulnerable populations, people living with HIV/AIDS and their affected families and
communities, and the general public).
The details and costing of the Roadmap to UA and the investment plan for AMTP4 are still being finalized
at the country level. Evidently, the UA will help push forward the agenda of preventing the HIV epidemic
until 2010. The UA goals and objectives define the mid point to the 2015 MDG. This proposal takes into
consideration the broader framework of the Millennium Development Goals, the Medium Term Philippine
Development Plan and the Universal Access Initiative. The main context of the relationship to the
development goals are: (1) Treatment of HIV infection is costly at the family, community and government
level considering the increased out of pocket source of health spending (PNHA 2004); and, (2) The
government cannot shoulder much of the spending that will be brought about by massive epidemic
considering the high burden from the external debt, high budget deficit and moderate economic growth.
The over-all goal is to fully strengthen and increase the coverage and provide expanded prevention early
into the epidemic could prevent the intervention of treating more HIV infection.
4.4.4 National health system
a) Briefly describe the (national) health system, including both the public and private sectors, as
relevant to reducing the impact and spread of the disease in question.
The national response to HIV and AIDS is led by the Philippine National AIDS Council (PNAC), which
was established in 1992 as a multi-sectoral body of government and civil society organizations. The
National AIDS STD Prevention and Control Program (NASPCP) under the Department of Health was
established in 1987 to guide the health sector response at the local and the national level. The NASPCP
supervises the 6 treatment centers that were set up by the Global Fund Round 3 in four geographical
zones. The treatment centers are located in Metro Manila (3 hospitals), in Northern Luzon, Visayas and
in Mindanao, which covers 5 regions and 1 Autonomous Region of Muslim Mindanao. Additional
treatment center will be added under Global Fund Round 5 in the Bicol region in Luzon. Most of these
hospitals are located in urban center or at the regional center providing services to 4 or 5 referring
provinces. The regional hospital is also the main facility providing for the collection, testing and
33
distribution of blood and blood products.
Another domain that the NASPCP oversees is the Social Hygiene Clinics (SHC) located at the local
government unit. Although, health system is devolved, NASPCP provides updated guidelines on the
diagnosis and management of STI cases, technical assistance to field staff and quality assurance to
health programs on STI/HIV/AIDS. SHCs are specialized STI clinics providing STI services for registered
entertainment workers and other clienteles. It issues and renews health cards to registered entertainers
who underwent regular routine laboratory testing for STIs. SHC also functions as a venue for counseling
during weekly consultations of sex workers, focal point for the conduct of local surveillance and the
secretariat of the Local AIDS Council (LAC).
Government and private hospitals as well as HIV testing centers are areas that NASPCP oversee in the
conduct of HIV/AIDS prevention services (STI diagnosis and treatment, VCT, HACT or the HIV/AIDS
Core Team functions). In the conduct of its functions, the NASPCP has its support arm within the DOH:
NEC, the national reference laboratories, the Bureau of Health Facilities and Services (BHFS) and the
National Center for Health Facilities and Development (NCHFD).
The NEC is designated as the AIDSWATCH of the DOH. It aims to determine the magnitude and
progression of the HIV infection in the country and evaluate the adequacy and efficacy of the
countermeasures being employed. NEC has established its passive (Registry) and active (Serologic and
Behavioral) HIV/AIDS surveillance systems. The National HIV/AIDS Registry provides profile of confirmed
HIV positive cases coming from hospitals, clinics, laboratories and blood service facilities. The National
HIV/AIDS Registry also reports HIV positive cases among migrant workers. The active surveillance
system is an early warning device that monitors the spread of the disease. It also monitors risk behavior
that could put the population at risk for HIV. With the evolution of surveillance in other neighboring Asian
countries, the country’s surveillance system also evolved. Behavioral and serologic surveillance was
conducted in tandem in 2005 (IHBSS). Second generation surveillance is being implemented by the NEC
to define the magnitude of HIV epidemic in the Philippines. With second generation surveillance, STI
surveillance system through SSESS is established initially in 13 sites and expanded to 11 Global Fund
sites of round 3. In 2005, through NEC’s collaboration with Family Health International (FHI), estimates of
the risk groups was done. Also, one of the regular activities of NEC to complement the existing
surveillance system is the conduct of estimation of PLWHAs in the country. This is being conducted every
two years. IHBSS is also recommended to be conducted every two years instead of the annual schedule
in the past. SACCL and RITM are the laboratory arms of NEC in its conduct of surveillance. They provide
confirmatory tests to all reactive samples during the conduct of surveillance. Both laboratories provide
the quality assurance program for social hygiene clinics, HIV testing kits and blood service facilities.
The BHFS is the licensing arm of the DOH. Through its regulatory mechanism on the accreditation of HIV
testing centers, quality of service delivery is ensured. In 2005, the Bureau issued an administrative order
requiring all HIV testing centers to set up a VCT area and offer VCT in the facility. On the other hand,
NCHFD develops programs, strategies and policies related to health facility development, operation and
maintenance.
NASPCP also collaborates with other agencies within and outside DOH regarding HIV/AIDS prevention
program. One major program within the DOH that it has to work with is the NVBSP. The NVBSP or the
National Voluntary Blood Services Program is in charge of ensuring the safety of blood for transfusion.
Collaboration of the two programs should work beneficially to both: blood safety as one of the major
strategies in the prevention of HIV/AIDS and HIV/AIDS prevention as one of the tools to ensure safe
blood supply. However, study conducted in 2005 by NEC showed the absence of collaboration between
the two programs. Moreover, inclusion of basic HIV/AIDS information and prevention in the IEC materials
used during pre-donation counseling and during community advocacy is lacking. There is still proliferation
of hidden paid replacement donors that could pose as threats in the spread of HIV/AIDS and endanger
the safety of blood supply in the country. Post donation counseling as well as self-deferral is weak and
referral to treatment, care and support is almost negligible because of the absence of VCT link. Also,
there has been problem on the rational use of blood. Eighty percent of blood requested by physicians for
transfusion are whole blood while 20% are blood components which ultimately lead to high wastage rate.
Prevention interventions are also being carried out by private non-government organizations. The work
with hard-to-reach MARP as well as condom use advocacy have been very promising because of this
collaboration between the government and NGOs. There has to be more efforts that need to be exerted
when it comes to facility-based STI diagnosis and treatment, particularly in the private sector. Partnership
has to be forged and policies set to address the gaps in STI referral system and reporting. Reproductive
health program, particularly among males is still a new area to explore. A formal PMTCT program and
34
PEP has never been started because of the lack of national guidelines for implementation.
Migrant workers are being addressed by a number of non-government agencies as well as the DOH,
Department of Foreign Affairs and OWWA. However, an effective HIV/AIDS/STI prevention services
including VCT has not yet been institutionalized.
Currently, the Philippine Health Insurance System is developing a health insurance benefit package for
HIV/AIDS services. The DOH purchased $160,000 worth of ARV in 2005. Guidelines on the access and
utilization of ARV were developed and Memorandum Circular 2006-0026 was issued (Annex 15).
b) Given the above analysis, explain whether the current health system will be able to achieve and
sustain scale up of HIV/AIDS, tuberculosis and/or malaria interventions. What constraints exist?
The current health system is beset with a number of constraints like limited budget for government
program implementation, fast turn over of personnel due to migration, lukewarm partnership with the
private sector, the demand for a major change in the program particularly on the blood program.
Despite the above constraints, the current health system will be able to achieve and sustain HIV/AIDS
interventions for the following reasons: First, the Philippines has already complied with the “3 Ones” of
UNAIDS, that is, one national authority, one national framework and one national M&E that could serve
as backbone of all national HIV/AIDS efforts. Second, Local AIDS Council serving as coordinating arm of
all HIV/AIDS prevention and treatment, care and support services at the community level have been
established in many key cities. Third, existence of institutionalized facilities like the SHC and treatment
hubs that offer regular services to STI clients and HIV/AIDS patients. Fourth, support and collaboration
from among the different national government agencies to ensure implementation and sustainability. Fifth,
existence of an institutionalized reporting as well as surveillance system to gauge magnitude of HIV/AIDS
as well as countermeasures. Sixth, presence of legal mandates to enforce policies created to implement
prevention and treatment, care and support efforts. Seventh, there is strong partnership between the
national government and multilateral and bilateral agencies. Eight, the strong working relationship
between the government and NGOs. Lastly, the high level of political commitment and leadership that
backs up a well planned national program on HIV/AIDS.
The current health system may be able to achieve and scale up HIV/AIDS interventions with sustained
provision of support from the national government as well as from international donor partners. Upgrading
the whole health system entails larger amount of money as more staff is needed, more trainings and
facility upgrading is needed. The national and the local government though has been increasing its
spending since 2003. The health sector, needs to develop sustainable mechanisms (social marketing,
health care financing) to cope with the increasing demand for equitable, quality services.
The local government units are the only government entity that has an increasing budget as part of the
internal revenue allotment. These are opportunities that can be tapped to increase the level of response,
increase coverage for services and reach more people.
c) Please describe national health systems strengthening plans as they relate to these constraints.
If this proposal includes a request for resources to help overcome these constraints, describe
how the proposal will contribute to strengthening health systems.
Health Systems Strengthening
Constraints
Health Care Financing
Sustainability of VCT services, ARV, health
insurance, livelihood package, blood services
Health system inputs
STI drugs, ARV
Human resources
Fast turn over of staff
Capacity building
Lack of skills in VCT, STI diagnosis &
treatment
Lack of upgrading in terms of project
35
management, procurement and supply
Health Information System
Lack of skill by field staff
Sequential testing of blood units
Health service delivery
VCT, Quality Assurance Program
Lack of Testing Facilities
Reporting mechanisms
Policy Development
National guidelines on PMTCT, VCT, ARV
Community Systems Strengthening
Functionality of LAC and Local Blood Council
Since Global Fund project is limited to five years, sustainability mechanism has to be in place during
project implementation. Consultancy firm will be hired to study and assist the DOH on the social
marketing scheme for ARV and VCT during the life span of the project. Likewise, livelihood package as
well as health insurance benefit package will be provided for the PLWHAs to empower them to live a
quality existence.
ARV is still new in the Philippines. The high cost may still compete with the government’s expenditure for
other essential drugs. Provision during the project span may ease out the burden from the government
while a marketing strategy is being developed and pilot tested. Likewise, STI drugs may not be readily
available in the other eight sites where SHC and other HIV/AIDS prevention efforts are not yet validated
to be in place. Provision of start of drugs during project implementation may inspire local government
executives to give their commitments and forge partnership with the national AIDS program.
Since the country is beset with out migration because of economic reasons, the project will be hiring staff
at the SHC and sub-national coordinator to assist the existing personnel in the conduct of his/her task
without adding burden to the regular workload, except for technical advice as regards to project
operations and management at the local and sub-national levels.
An important area to be funded by the project is capacity building of program implementers. Since Global
Fund is keen on sustainability, it must be noted that only with good leadership can any project or program
be sustained. Good leadership entails skills development in all areas of expertise. Trainings on VCT, STI
clinical management, BCC, surveillance, cold chain management, total quality management will be
provided to project implementers at the national, sub-national and local levels in both the government and
private counterparts.
In a study conducted regarding HIV positive among blood donors and the national blood program,
sequential testing is being implemented because of lack of funds. By doing this, the country cannot have
a true picture on the magnitude of HIV infection among blood donors, hence, among the general
population. This project will be testing all blood units for HIV-antibody. Added to that, since we are
seeing STI as an important surrogate for HIV especially in low level epidemic country like the Philippines,
it has been decided that 4 other TTIs (2 of which are STI:hepatitis B and syphilis) be included in the
request for funding. Philippines is known to have areas endemic for malaria which incidentally is one
among the 5 TTIs this project will be covering. Malaria screening will be an additionality in the course of
conduct of a major strategy in HIV/AIDS prevention, that is, blood safety.. The National Blood Program
has been funding these tests prior to the centralization of the blood bank system. However, since it is
facing the major challenges of the move to centralize, resources are still needed to test blood units free of
HIV and other TTIs for transfusion. Currently, the blood program has to deal with the 50,000 loss from the
closure of commercial blood banks. Only 400,000 blood units will be requested for funding for the next
five years with the established cost recovery mechanism to fund for the additional need of the country.
One of the weaknesses noted in the implementation of many of the previous Projects includes having a
weak project management staff, who are not skilled in finance management, procurement and supply
management and M&E. Technical assistance will be requested to enhance the skills of PMO staff.
Cost of surveillance will be requested for funding by the Global Fund. Surveillance may be expensive but
this is the tool by the government for evaluating project implementation. Likewise, funding for the
information system by the blood bank will also be requested during the first three years since a cost
36
recovery mechanism through subscription by private BSF. IBBIS provides a mechanism to trace hidden
paid replacement donors and avoid duplication of records.
Experiences in the past showed that Quality assurance program cannot be conducted regularly because
of lack of funds. However, quality cannot be compromised if effective project implementation is required
especially if laboratory diagnosis and blood safety are the issues.
Partnerships need to be forged especially at the community level. Since health system in the Philippines
is devolved, regular advocacy meetings have to be conducted to develop plans for implementation of the
council. The council at the local level is the coordinating and harmonizing body of all HIV/AIDS prevention
efforts in the community.
Two additional treatment centers will be established in areas known to cater a numbers of PLWHAs
These are located in Western Visayas which could be the referral center of nearby cities and towns that
are frequented by tourists. The other one in Cagayan Valley, which is strategic location for business
travelers from the northern part of the country.
4.5 Financial and programmatic gap analysis
Interventions included in relation to this component should be identified through an analysis of the gaps in the
financing and programmatic coverage of existing programs. Such an analysis should also recognize gaps in
health systems, related to reducing the impact and spread of the disease. Global Fund financing must be
additional to existing efforts, rather than replacing them, and efforts to ensure this additionality should be
described. For more information on this, see the Guidelines for Proposals, section 4.5.
Use table 4.5.1-3 to provide in summarized form all the figures used in sections 4.5.1 to 4.5.3.
4.5.1 Overall needs assessment
a) Based on an analysis of the national goals and careful analysis of disease surveillance data and
target group population estimates for fighting the disease component, describe the overall
programmatic needs in terms of people in need of these key services. Please indicate the
quantitative needs for the 3-5 major services that are intended to be delivered (e.g. anti-retroviral
drugs, insecticide-treated bed nets, Directly Observed Treatment Short-Course for TB treatment).
Also specify how much of this need is currently covered in the full period of the proposal by
domestic sources or other donors. Please note that this gap analysis should guide the completion of the
Targets and Indicators Table in section 4.6. When completing this section, please refer to the Guidelines for
Proposals, section 4.5.1.
With an estimated 11,186 adults living with HIV/AIDS of whom 74% are from the the general population in
2005, the country is confronted with a challenge of the spread of HIV. The National HIV/AIDS Registry is
37
regularly reporting an increase of 30 cases per month and the 2005 IHBSS has clearly shown the population
overlap between the MARP and the general population through unprotected sexual relationship and/ sharing
of used injecting needles and syringes. The 2005 IHBSS also detected HIV positives among IDUs, FSW and
clients of sex workers. Likewise, a study conducted in 2005 showed that there is also an increasing trend of
HIV positive among blood donors (2000: 4/100,000; 2001: 3/100,000; 2002: 2/100,000; 2003: 6/100,000;
2004: 8/100,000).
The national goal is to sustain the less than 1% HIV prevalence and reduce the impact of HIV/AIDS among
PLWHAs, their families and significant others. Analyzing the gaps in the national AIDS program led us to
identify four major areas or services that are covered by the proposal and which will cover the population
that the program deemed it necessary to address at the moment.
Resource Need Model (RNM), a system of computing for the resources needs utilizing the latest local
available data derived from the HIV surveillance, 2005 estimates of people living with HIV/AIDS and the
actual documented accomplishments (taking into consideration the rounds 3 and 5 targets), was used.
Based on this model, the country has big programmatic gaps in the four areas identified:
Unmet Needs by 2010
(1) VCT: approximately 3,132,656 Filipinos will be needing VCT services
(2) PMTCT: 5,659 HIV positive mothers need to be enrolled in PMTCT program
(3) Blood Safety: 171,798 blood units have to be tested for HIV
(4) ARV: 350 PLWHAs will be needing ARV
VCT has just been recently introduced to the public and the NGO sector. The estimated programmatic
needs for VCT services is at 94% of the total national needs (if 5% of the total adult population have access
to VCT). Programs for returning migrant workers and their families have to be established because at
present, only pre-departure orientation services were given as prevention interventions and only for
departing migrant workers.
PMTCT program has not been put in place yet. There is no PMTCT Program integration with the ante-natal
care services except for 1 hospital in Metro Manila. PMTCT guidelines are not yet developed. The June
2006 National HIV/AIDS Registry has shown a 1.4% peri-natal transmission. Based on the RNM Model,
around 5,659 HIV positive mothers would need to be enrolled in a PMTCT program including provision of
milk formula.
For blood safety as a strategy to prevent the spread of HIV/AIDS, around 171,798 blood units need to be
tested for HIV antibodies in 2010. It is assumed that the increased efforts of the national blood program will
cover for the big gap from 2007 to 2010. The present algorithm follows sequential testing, which embodied in
the Manual of Standards for Blood Banks and Blood Centers. However, it is important to test all blood units
to monitor the safety of blood donated and the blood donor recruited and to give the country the real
magnitude of HIV infection among blood donors and the general population. Challenged with the closure of
commercial blood banks, the national blood program has to compensate for the annual 75,000 more blood
units supposed to be coming from the commercial blood banks. The blood program also has existing gaps in
carrying out the promotion of voluntary blood donation including conduct of mobile blood donations activities
at local level.
By the end of 2010, a total of 350 PLWHAs will still be needing ARV. This is outside the on-going treatment
program of the Department of Health and the Global Fund Rounds 3 and 5.
Programmatic Gap Analysis
Actual
2004
Anticipated
2005
2006
2007
Estimated
2008
Comments*
2009
2010
3,362,656
3,362,656
A. People in NEED of Key Services (3 to 5) delivered in the grant component:
Key Service 1 (VCT
service)
3,035,737
3,152,399
3,168,457
3,234,596
3,299,441
Based on the RNM
computation (5% of
the total adult
population)
38
Key Service 2 (PMTCT
– pregnant HIV+ women
on ARV)
Key Service 3 (Blood
Safety _ HIV Tested
Blood units)
823,855
188
626
1,373
2,488
4,025
5,669
838,441
852,904
867,277
881,520
895,729
909,804
400
600
600
700
700
800
Key Service 4 (ARV
Provision)
Based on the RNM
computation
Based on RNM
computation
estimated
B. People CURRENTLY RECEIVING or ANTICIPATED TO RECEIVE Key Services (3 to 5) delivered in the grant component as
financed by current or anticipated resources:
Key Service 1 (VCT
service)
on ARV)
Safety _ HIV Tested
Blood units)
Key Service 4 (ARV
Provision in government
centers)
21,000
21,000
140,000
150,000
180,000
200,000
200,000
Implementation of
VCT in OFW clinics
will increase the VCT
services in 2006
(private sector)
0
0
5
10
10
10
10
Estimated based on
the referred cases to
the treatment centers
in Metro Manila
247,157
296,588
355,906
427,087
512,504
615,005
738,006
0
72
170
300
400
400
450
1
Program estimation
GF Rd 3 (170) and Rd
5 (200) plus DOH
ARVs
1
1
2
2
C. UNMET NEED OR GAP in terms of people in need of Key Services delivered in the grant component (A – B = C , A – B =
2
C etc.)
Key Service 1 (VCT
service)
3,014,737
3,131,399
3,028,457
3,084,596
3,119,441
3,162,656
3,162,656
Expansion of
VCT at the
government
centers is not yet
accounted
188
621
1,363
2,478
4,015
5,659
Referral centers ha
snot been established;
no or limited HIV
education in ANC
setting
541,853
496,998
440,190
369,016
280,724
171,798
328
430
300
300
300
350
on ARV)
Safety _ HIV Tested
Blood units)
576,698
Key Service 4 (ARV
Provision in government
centers)
Sequential testing did
not permit the testing
for HIV
PLWHA has self
stigma, community
stigma; estimates
were based on 11,000
cases in 2005
*Comments: Please provide specify information concerning the groups targeted and any assumptions including target size.
b) Based on an analysis of the national goals and objectives for fighting the disease component,
describe the overall financial needs. Such an analysis should recognize any required investment in
health systems linked to the disease. Provide an estimate of the costs of meeting this overall need
and include information about how this costing has been developed (e.g., costed national
strategies, medium term expenditure framework). (Actual targets for past years and planned and
estimated costing for future years should be included in table 4.5.1-3 [line A].)
It must be noted here that the amounts used for the Indicative Resource Requirements as stipulated in the
Fourth AIDS Medium Term Plan does NOT reflect the total resource needs but rather the capacity of both the
Philippine Government and the NGOs to absorb the costs of working towards attainment of the goals of
AMTPIV. Thus, the Resource Requirements merely reflect allocated annual budgets from government
39
agencies and some NGOs rather than a comprehensive package of interventions/responses.
The official costing of the total amount needed by the country has not been developed so far. The Philippine
National AIDS Council has an on-going initiative to quantify investment requirements for the AMTP4. Due to
the unavailability of official reports, the Resource Needs Model output were used to estimate resource
requirements for the comprehensive delivery of HIV AIDS packages. The inherent assumptions of the model
were used during the computation, which may not be exactly true to the Philippines because of the low level
epidemic status. Cost for the impact mitigation was excluded from the computation.
For 2006, the resource requirement for comprehensive HIV response was computed to be around
US$30,420,000. The cumulative annual resource needs from 2006 to 2010 was estimated at
US$275,091,102. The increasing spending was based on the RNM model projections and does not cover
possible reductions in cost if effective prevention and treatment is put in place early in the epidemic.
(See Table below)
4.5.2 Current and planned sources of funding
a) Describe current and planned financial contributions, from all relevant domestic sources
(including loans and debt relief) relating to this component. (Summarize such financial amounts for
past and future years in table 4.5.1-3 [line B].)
The Philippine national government health spending for HIV and AIDS significantly declined in 20002001. This is partly because there is not yet a complete accounting of the local implementation of HIV
programs from the local governments after the full decentralization took place in year 2000 and that there
had been continuing big budget deficits from the national government. Based on the Philippine National
Health Accounts (PNHA) of 2004, the national government per capita spending and the social health
insurance spending are increasing at 24% and 9% respectively. The budget of the local governments
(decentralized) has been increasing with full internal revenue allotment now being given to them. The
opportunity rise in the increasing budget of LGU and the autonomy to use their income for developmental
and socio-cultural initiatives. Within the local funds, 5% is allotted for gender and development which
could include activities and programs related to HIV and AIDS. The focus of advocacy is to greatly
influence the local chief executives to invest in prevention and treatment of HIV and AIDS through a multisectoral response.
The national government source of financing mainly comes from the budget of the National AIDS STD
Prevention and Control Program and the Philippine National AIDS Council, both under the budget ceiling
of the Department of Health. In 2005, the DOH procured PhP10M worth of antiretroviral medicines to
supplement the Global Fund procured ARVs. Other government agencies has budget for specific HIV
prevention programs such as the Department of Education, Department of Labor and Employment and
other PNAC member agencies. In 2004, the total government spending for HIV and AIDS is $594,000. It
is expected to increase based on the increasing trend of national and local government spending for
health.
b) Describe current and planned financial contributions, anticipated from all relevant external
sources (including existing grants from the Global Fund and any other external donor funding)
relating to this component. (Summarize such financial amounts for past and future years in table 4.5.1-3
[line C].)
External support mainly comes from the multilateral, bilateral partners, international and donor agencies
such as the Global Fund, USAID, UN agencies such as WHO, UNAIDS, UNFPA, UNICEF and ILO.
Loans through World Bank, ADB and other International Financing Institutions have also been tapped to
strengthen the health systems, including the procurement of condoms for social marketing.
Data from the National AIDS Spending Assessment (NASA) emphasizes the need for a substantial
increase in resources to prevent and control the spread of HIV/AIDS. Moreover, based on the NASA, the
government provided only about PHP33 million (US$594,000) which may largely exclude local funds
being spent at the local level as there where fewer local governments included in the assessment in
2004.
40
Loans/grants from external sources are important financing support for many health programs including
HIV/AIDS. The Condom social marketing program supported by KfW external financing will provide
500,000,000 worth of condoms through out the country. In addition, a portion (10%) of the Second
Women’s Health and Safe Motherhood Project were also included as domestic sources as it has a
component on STI and HIV/AIDS. A portion of the loan for the upgrading of 3 treatment hubs under the
upgrading of DOH hospitals were likewise included as part of the domestic resource.
Global Fund’s initial grant to the Philippine HIV/AIDS Program was in year 2004 (Round 3) in the amount
of US$3,496,865 (Phase 1). For 2006, because of another grant is scheduled for grant signing this year
and the approved Phase 2 budget for Round 3, the total HIV/AIDS resources from Global Fund will be
US$ 5,955,900.
4.5.3 Financial gap calculation
Provide a calculation of the gap between the estimated overall need and current and planned
available resources for this component in table 4.5.1-3 and provide any additional comments below.
The estimated financial gaps of the country based on the computations made based on the Resource
Needs Model projections of the programmatic gaps and the data from the National AIDS Spending
Assessment has provided the country estimates for the needed resources until 2010. NASA has pointed
out the large proportion of externally funded AIDS response in the country in 2000-2004 where
government spending totaled to only US$594,000 in 2004. These however does not account for the
spending of most of the local governments.
Because the national HIV/AIDS investment plan has not been done and officially endorsed by the
Philippine National AIDS Council, computation were made through the RNM based on the assumptions of
the programmatic gaps until 2010 and using the best available costing estimates. For 2006, the resource
requirements for comprehensive HIV response were computed to be around US$ 30,420,000. The
cumulative annual resource needs from 2006 to 2010 was estimated to be US$ 275,091,102. The
increasing spending was based on the RNM model projections and does not cover possible reductions in
cost if effective prevention and treatment is put in place early in the epidemic.
About 72 percent of total resource requirements will be for prevention activities. These include: activities
geared towards priority populations (such as youth, sex workers, workplace, IDUs, MSMs, migrant
workers); service delivery (condom provision, STI management, VCT, PMTCT, mass media); and health
care (blood safety, post-exposure prophylaxis, safe injection universal precautions). On the other hand,
roughly 23 percent will be for care and treatment services. These include: home-based care, palliative
care, diagnostic testing, treatment of OIs, ARV therapy, tuberculosis, nutritional support, training,
Laboratory HAART, and OI prophylaxis. Meanwhile, about 4.8 percent goes to policy, advocacy,
administration and research. The estimates are for funding required for a comprehensive response to the
epidemic and with programs covering around 60 percent of target population.
41
Please summarize the information from 4.5.1, 4.5.2 and 4.5.3 in the table below.
Table 4.5.1-3 - Financial contributions to national response
Financial gap analysis (please specify currency: US$)
Actual
2004
Overall needs costing (A)
18,000,000
Planned
2005
23,400,000
2006
30,420,000
Estimated
2007
39,546,0000
2008
51,409,800
2009
66,832,740
2010
86,882,562
Current and planned sources of funding:
Domestic source: Loans and debt relief
(provide donor name)
2,654,000
3,893,782
3,893,782
3,893,782
3,893,782
3,893,782
654,000 (Loan-KfW)
654,000 (Loan-KfW)
654,000 (Loan-KfW)
654,000 (Loan-KfW)
654,000 (Loan-KfW)
654,000 (Loan-KfW)
2,000,000 (Loan – KfW)
2,000,000 (Loan – KfW)
2,000,000 (Loan – KfW)
2,000,000 (Loan – KfW)
2,000,000 (Loan – KfW)
2,000,000 (Loan – KfW)
1,239,782 (Loan –
Netherlands)
1,239,782 (Loan –
Netherlands
1,239,782 (Loan –
Netherlands
1,239,782 (Loan –
Netherlands
1,239,782 (Loan –
Netherlands
594,000
Domestic Source¹
(did not adequately covered
LGU budget, and
government loans were
part of external sources)
594,000
1,772,200
1,825,366
1,880,127
1,936,530
1,994,627
594,000
3,248,000
5,665,982
5,719,148
5,773,909
5,830,312
5,888,409
Total domestic
sources of funding(B)
External source 1
Global Fund Grants
3,496,865
5,955,900
3,466,142
External source 2
2,231,000
UNICEF, USAID, UNFPA, KfW, WHO, UNAIDS, Packard,
JICA, DFOD UK, UK Alliance, Plan Phil
2,231,000
External source 3
ADB
2,231,000
2,231,000
2,231,000
2,231,000
2,231,000
600,000
Total external
sources of funding (C)
5,727,865
2,231,000
8,786,900
2,231,000
5,697,142
2,231,000
2,231,000
Total resources available (B+C)
6,321,865
5,479,000
14,452,882
7,950,148
11,471,051
8,061,312
8,119,409
11,678,135
17,921,000
15,967,118
31,595,852
39,938,749
58,771,428
78,763,153
Unmet need (A) - (B + C)
¹ includes budget from national, local (PS & MOOE) estimated at 3% increase per year both for AIDS and Blood Programs
42
4.5.4 Additionality
Confirm that Global Fund resources received will be additional to existing and planned resources,
and will not substitute for such sources, and explain plans to ensure that this will continue to be true
for the entire proposal period.
The National government has budget for coordination, policy development and provision of technical
assistance including augmentation of drugs and medicines to some local governments. Currently, the
NASPCP has US$100,060 regular budget which goes to STI drugs allocated in each sub-national DOH
offices and reagents for confirmatory testing. Other offices within the DOH and other government
agencies which are part of the Philippine National AIDS Council have their own share of funds for
HIV/AIDS program. Evaluation done by different local and external consultants have shown the need to
start up high impact projects to boost both the national and the local responses and prime up other local
governments to establish a more comprehensive HIV programs.
This proposal is requesting for US$18.3 M to jumpstart the country’s VCT and blood safety as strategies
for HIV/AIDS prevention, treatment and care. Likewise, it will also be funding the strengthening of major
health systems, particularly, surveillance, referral system, health insurance and public-private partnership.
For the blood program the Project will only support 10% of the total HIV and other TTI tests needed to
cover expected gaps from the impending commercial blood banks.
The proposal will cover 16 of the country’s 59 identified risk sites (based on PNAC criteria), which
accounts to 29% of the total estimated female sex workers and MSM in the country.
Based on the 2004 Philippine National Health Accounts (PNHA), the government per capita spending for
health was increased by 23.4% in 2004. The spending from the social health insurance has also
increased to 9% of the national health spending. Existing funds will be increased through continuous
lobbying for more funds at the Congressional level, including the on-going revision of the Republic Act on
Prevention of AIDS (RA 8504). Local governments, were advocacy is being done are expected to fund
the manpower and other logistical component of any local response including Global Fund Project.
(Annex 15 Philippine National Health Accounts 2004)
4.6 Component strategy
This section describes the strategic approach of this component of the proposal, and the activities that are
intended in the course of the program. Section 4.6 contains important information on the goals, objectives, service
delivery areas and activities, as well as the indicators that will be used to measure performance.
For more detailed information on the requirements of this section, see the Guidelines for Proposals section 4.6.
In support of this section, all applicants must submit:
• A Targets and Indicators Table. This is included as Attachment A to the Proposal Form.
(When setting targets in this table, please refer explicitly to the programmatic need and gap
analysis in section 4.5.1 a. All targets should show clearly the current baseline. For definitions of
the terms used in this table, see the M&E Toolkit provided by the Global Fund. Please also refer to
the Guidelines for Proposals, section 4.6.
and
• A component Work Plan covering the first two years of the proposal period. The Work Plan should
also be integrated with the detailed budget referred to in section 5.2.
The Work Plan should meet the following criteria (Please refer to the Guidelines for Proposals,
section 4.6):
a. It should be structured along the same lines as the Component Strategy - i.e. reflect the same
goals, objectives, service delivery areas and activities.
43
b. It should cover the first two years of the proposal period and should:
i be detailed for year 1, with information broken down by quarters;
ii be indicative for year 2.
c. It should be consistent with the Targets and Indicators Table (Attachment A to the Proposal
Form) mentioned above.
d. It should be integrated with the first two years of the detailed budget (please refer to section
5.2).
Please note that narrative information in this section 4.6 should refer to the Targets and Indicators Table
(Attachment A to this Proposal Form), but should not consist merely of a description of the table.
4.6.1 Goals, objectives and service delivery areas
Provide a clear description of the program’s goal(s), objectives and service delivery areas (provide
quantitative information, where possible).
GOAL 1: To maintain a less than 1% HIV prevalence by scaling up VCT and ensuring safe blood
supply
After analysis of the epidemiologic situation in the country and the programmatic gaps, the members of the
Philippine National AIDS Council (PNAC) decided to prioritize these two areas which will contribute to
maintaining the low HIV prevalence in the Philippines. While GFATM rounds 3 and 5 focus on the most at
risk population, round 6 will cover an essential proportion of the general population: the blood donors and
clients of VCT centers including migrant workers. Since VCT will be situated in both private and public
facilities, particularly the social hygiene clinics at the community level, it will also target MARP accessing
these facilities. There are two main objectives under this goal:
Objective 1: Increase access of the most at risk and general population to VCT
Service Delivery Areas: BCC: community outreach, STI diagnosis and treatment, testing and
counseling, PMTCT, information system (surveillance and operational research)
Since 1993, when HIV surveillance system has been established, there has never been a clear
delineation between case finding and surveillance. Surveillance was used as a tool for finding HIV
positive cases until 2005 when the system adopted new methodology and evaluation by WHO
recommended the setting up of VCT centers in the country.
This proposal will take on the said recommendations in 16 sites, eight of which are previous sentinel
sentinel sites and eight are identified as cities that are currently evolving in terms of urbanization and
migration. Centers for VCT will be the social hygiene clinics and partner private and government
hospitals. Social hygiene clinics are institutionalized facilities catering to establishment based sex
workers and entertainers for certification of their health cards. Most of these clinics have already been
offering counseling during scheduled consultations for STI clearance, excluding HIV, either group or
individual.
The proposal envisions a partner private VCT center to cater to the general population, particularly,
housewives, male clients of sex workers, migrant workers and youth, who are uncomfortable
accessing the SHC services due to stigma associated to SHC. Modules on VCT are already
developed and being pilot tested. Part of the initial activities will be review, revision and
standardization of the VCT module followed by training in four batches of 96 key personnel in the
different levels in year 2. Global Fund will also support the setting up of 16 VCT areas in the identified
VCT facilities as well as the procurement of HIV testing kits and the quality assurance program. At the
community level, local facilities through the 16 Social Hygiene Clinics and regional medical centers will
be enhanced to cater to the growing demand for HIV and STI services. There will be a total of 14,230
VCT services provided during the course of the Project catering to the needs of approximately 25,949
most at risk population (female sex workers, Male having sex with male and clients of sex workers).
VCT has no client preference and in this proposal will be set up in hospitals and the SHC where target
specific BCC strategies will be delivered. The proposal also covers for peer education at the SHC, STI
44
management and migrant worker’s education at the local pre-employment service office (PESO).
Local and national public-private collaboration for STI and HIV AIDS, surveillance and improvement of
data collection system will also be supported.
A marketing firm will be contracted out to develop a strategy to sustain the VCT centers when the GF
project ends. An operational research will also be conducted for the first two years to identify factors
that are essential in sustaining a VCT center, focusing on the migrant workers, one of the biggest
prospective clienteles of the said service..
One important gap that the round 6 proposal addresses is the PMTCT program in the country. The
National HIV/AIDS Registry of the Department of Health has shown that 1.4% of reported cases are
perinatally transmitted. For the past years, only informal referrals from the treatment hubs to tertiary
hospitals catering to Obstetrics patients were done. Round 6 will utilize the VCT centers as entry
points of HIV positive pregnant mothers to PMTCT program thus preventing spread of HIV from
mother to child. A total of 25 HIV positive mothers will benefit from the Project including provision of
ARV and milk formula. National guidelines will be developed and popularized and training of
physicians in eight treatment hubs and five additional hospitals will be done in year 2.
Objective 2: Ensure safe blood supply
Service Delivery Areas: BCC: mass media, BCC: community outreach (public education), blood safety
In low level HIV epidemic countries like the Philippines, monitoring the prevalence of HIV among blood
donations provides an indication of the trends in the spread of HIV in the general population. “Study of
Confirmed HIV Positive Among Blood Donors and Evaluation of the National Voluntary Blood Services
Program” by the National Epidemiology Center of the Department of Health revealed an increasing
trend of HIV positive during blood donations from 2002 to 2004 (2/100,000: 2002; 6/100,000: 2003
and 8/100,000: 2004). Several gaps identified in the study will be addressed in the round 6 proposal:
the weak coordination between the National AIDS Program and the National Blood Program, the lack
of IEC materials that feature not only healthy lifestyle but also prevention of transfusion transmissible
infections especially on HIV/AIDS, the high number of hidden paid replacement donors, the weak pre
and post donation counseling and the lack of referral from blood service facility to treatment, care and
support.
Tri- media will be tapped to highlight important events of the blood program and popularize a healthy
lifestyle and prevention of transfusion transmissible infections, including HIV/AIDS among the general
public. Video materials, posters and pamphlets will be reproduced and distributed in blood service
facilities. Public education will be conducted in the community through forums and through distribution
of learning materials in primary and secondary schools. To address the gap of hidden paid donors,
voluntary blood donation will be encouraged through community forums which will entice a pool of
volunteer blood donors. Training for advocates on volunteer blood recruitment will be conducted on
the first year. With this activity, the project is targeting that by the end of the fifth year 100% of blood
donation is voluntary.
Another important gap noted in the evaluation which is important to determine the magnitude of HIV
infection in blood donations is the conduct of sequential testing in government blood service facilities
due to lack of funds. GF round 6 proposal addresses this by funding the HIV tests and 4 other TTIs in
eight facilities (1 national, 3 sub-national, 12 regional blood centers).
“The quality of blood product is determined by the quality of source and the manufacturing process
that it underwent.” This is the concept of good manufacturing practice to ensure safe blood supply. It is
in this context that rational use of blood, cold chain management and screening blood products for
TTIs using the most appropriate tests (ELISA for HIV) will be done.
GOAL 2: To reduce the impact of HIV/AIDS among PLWHAs, their families and significant others
There have been efforts from the different NGOs to provide care and support for the PLWHAs. However,
the National HIV/AIDS Prevention and Control Program of the Department of Health aims to provide the
continuum of care that a PLWHA humanely deserves, from detection to care. The strategy of the program
is to make VCT the entry point for comprehensive treatment, care and support services. In collaboration
45
with the National Epidemiology Center through funding support from WHO and UNICEF, a new protocol
was developed and being pilot tested in 143 accredited HIV testing centers. The protocol emphasizes the
provision of pre and post test counseling to ensure referral to treatment hubs. To reinforce this national
endeavor, the Bureau of Health Facilities of the Department of Health issued an administrative order
requiring all HIV testing centers to set up VCT areas within their facilities. Hospitals are also required to
have their own HIV/AIDS Core Team (HACT). To prove its sincerity of providing holistic care for the
PLWHAs, the Department of Health in 2005, procured PhP 8 million worth of ARV which can be accessed
for free through the six treatment hubs.
This second goal has two principal objectives:
Objective 3: Scale up treatment, care and support for PLWHAs, their families and significant
others
Service Delivery Areas: ARV treatment and monitoring, prophylaxis and treatment of OIs, care
and support for the chronically ill, stigma reduction
Round 3 GF project established six treatment centers in three islands in the country (4 in Luzon, 1 in
Visayas, 1 in Mindanao). Round 5 will be establishing another treatment center in a strategic point in
Luzon, the Bicol region. Round 6 is targeting to establish two treatment centers in Visayas (Iloilo,
where 4% of reported HIV positive reside) and Cagayan Valley in Luzon. Since there will be an
overlap between rounds 5 and 6 implementation, the project will be procuring ARV on the third year for
200 PLWHAs. Round 6 will take on the PLWHAs enrolled in round 3 as well as the new PLWHAs
enrolled for round 6 on the third to the fifth year.
Training for HACT in the nine treatment centers as well as in hospitals located in 16 round 6 GF sites
will be provided for 5 years. This will tackle the clinical management of HIV/AIDS, including ARV.
Debriefing seminars will also be provided for health care providers. The project will also provide a
twice a year monitoring of the CD4 and viral load of 134 PLWHAs.
The Department of Health through the Philippine Health Insurance System is currently developing a
health insurance package for PLWHAs. The round 6 GF project will be enrolling 200 PLWHAs in the
insurance system. This is one of the priorities mentioned by the Secretary of Health during his meeting
with Dr. Richard Feachem in Geneva this year. Round 6 proposal also targets to develop a social
marketing scheme for the sustainability of ARV especially when the project ends. A consultancy firm
will be hired to help the Department of Health develop and implement this scheme during the project
span.
Aside from ARV provision, the project will also be procuring drugs for opportunistic infections like
gancyclovir, fluconazole, cotrimoxazole and intravenous antibiotics which will cover 100 PLWHAs per
year for 5 years. Vaccines against pneumococci, influenza, chicken pox will also be provided to 170
PLWHA as will be indicated in the national guidelines.
The Department of Health has seen the need of the PLWHAs for support beyond home visits. One
hundred PLWHAs will be receiving micro entrepreneurial training package as well as seed money for
the whole project span to achieve economic independence. At least 60 PLWHAs each year will be
provided support during referral to treatment hubs like transportation and accommodation allowance.
Community workers will also be provided with training on ARV adherence and two National
Conventions of PLWHAs will be conducted during the 5 year project life as a means of empowerment.
Stigma reduction will be addressed through symposia involving the PLWHAs, the local government
units, NGOs and faith-based organizations.
Objective 4: Strengthen health system to provide HIV/AIDS services
Service Delivery Areas: coordination and partnership development, strengthening of civil
society and institutional capacity building
The success of an HIV prevention effort lies on a scientific based national program backed up by high
level of political leadership, adequate funding and community involvement.
The concept of the proposal is strengthening the country’s health system anchored on the four pillars
of good governance, health care financing, regulation and service delivery. This has been evident in
46
the activities proposed.
This proposal will make use of the institutionalized reporting and referral systems instead of creating a
parallel system. Proper coordination will be observed through the sub-national offices of the
Department of Health and the local government units. Since the country is suffering from a fast turn
over of personnel, round 6 GF project will be hiring coordinators in each sub-national offices to
complement the existing manpower. He or she will be coordinating the activities in the sites covered
by the sub-national offices and will be reporting not only to the PMO but also to the local and subnational offices.
Based on RA 8504 or the Philippine AIDS Law, local AIDS Council will be established in every local
government units. This aims to empower the local council to plan and oversee HIV prevention and
control activities in their locality. There will be provision for the conduct of advocacy meetings for the
whole 5 years in the 16 round 6 GF sites. These advocacy funds from the Global Fund will only
complement the 10% allocated budget for HIV/AIDS in every local government unit.
Quality service delivery entails hard work and strong leadership. Strong leadership will only be
attained if the key players are equipped with knowledge and skills necessary to implement the
program. Technical assistance for program management, procurement and supply management, M&E
as well as other capacity buildings for program managers will be provided in this project. There will
be provision for the conduct of TWG and CCM meetings and annual partners’ meetings as tools for
monitoring project implementation and venues for sharing lessons learned. External evaluation will be
conducted before the end of phase 1 to institute corrective measures if deemed necessary.
Surveillance, particularly the IHBSS will serve as the evaluation tool of the Department of Health to
measure the outcome and impact of the project. Based on Department Order issued by the
Department of Health, the National Epidemiology Center (NEC) will serve as the M&E unit for the
Global Fund project. NEC will work hand in hand with the M&E unit of the PMO. Also, in compliance
with the unified M&E system on HIV/AIDS, NEC will submit report to the PNAC secretariat, designated
as the national M&E unit for HIV/AIDS.
The Department of Health thru the National AIDS/STI Prevention and Control Program (NASPCP), the
National Voluntary Blood Services Program (NVBSP) thru the Philippine National Blood Center
(PNBC) and the National Epidemiology Center (NEC) will take the lead in the implementation of this
project. It will take the lead in harmonizing all efforts from other government agencies concerned,
NGOs, private institutions, including hospitals, bilateral and multilateral agencies and the PLWHAs.
Since the project will be utilizing the expertise of government personnel and extra work hours to assist
PMO staff, monthly incentives to concerned personnel will be provided by the project.
4.6.2 Link with overall national context
Describe how these goals and objectives are linked to the key problems and gaps arising from the
description of the national context in section 4.4. Demonstrate clearly how the proposed goals fit
within the overall (national) strategy and how the proposed objectives and service delivery areas
relate to the goals and to each other.
The national goal of maintaining a less than 1% prevalence of HIV is the country’s battle cry. All of the four
objectives mentioned above will contribute to the reduction of number of new infections at both the most at
risk, other vulnerable and the general population. Reaching out and increasing coverage for the PIPs,
MSM and migrant workers will facilitate continued provision of education, behavior change communication
and necessary health service provision. Specific strategies such as outreach activities, peer education and
STI outreach will increase access of PIP and MSM to information and services such a counseling and STI
management that will protect them from acquiring HIV virus. For migrant workers, key information
education activities will also give some protection for HIV infection. It will also cover for the expansion of
VCT services at the SHC clinics at the local government level. The second objective will cover for the
general population, which is becoming more important. The focus of general prevention education is
school based, workplace and youth based. The proposal is focusing on the blood donor population, which
is also an important vehicle for transmission of HIV especially if the pool of donors are not coming from the
low risk population and that adequate testing is being carried out in all the blood units. Blood donor public
education as entry point for healthy lifestyle, behavior change modification and HIV prevention education
is an innovative strategy built within the proposal. The objective also covers other health care prevention of
HIV program such as VCT center to cater to general population at the hospital level; boosting up the
47
Prevention of Mother to Child Transmission (PMTCT) in the cities where the selected ARV treatment
centers are located and provision of post exposure prophylaxis (PEP) for health care workers and reenforcing universal precautions at the health facilities.
The third objective is on treatment care and support, which basically is provision of treatment for the 100
PLWHA, including laboratory support package, OI and care services. This will also be complemented by a
fourth objective on strengthening the health care system. Social health insurance system package will be
developed and all PLWHA will be enrolled to the system, improvement of information system, and
partnership development between stakeholders at the national and local level. Stigma reduction will also
be addressed through community and health facility based activities.
The achievement of the four objectives will create the network for the scaling of the continuum of care
approach from prevention to treatment and community based care and support. The multiplicity of players
involved in the implementation of the proposal will pave the way for scaling up towards 2010.
4.6.3 Activities
Provide a clear and detailed description of the activities that will be implemented within each service
delivery area for each objective. Please include all the activities proposed, how these will be
implemented, and by whom. (Where activities to strengthen health systems are planned, applicants are also
required to provide additional information at section 4.6.6.)
Objective 1: Increase access of the most at risk and general population to VCT
Service Delivery Area: BCC: community outreach
1. Train peer educators on target specific BCC, including condom negotiation skills & 100%
condom use program – 5 days training/site in 16 sites on the first year : local NGO
2. Conduct outreach activities for MARP (female sex workers, MSM) who are clients of Social
Hygiene clinics (SHC) – peer educators will assist the SHC physician, activities will include
HIV/AIDS prevention education, condom negotiation skills and distribution of condoms : SHC
3. Train migrant workers and or their family members as advocates in 16 sites – a local
government unit (LGU) desk will be set up in the local chief executive’s hall where IEC materials
on HIV/AIDS prevention will be available, local staff from the pre-employment service office will
be assigned to man this desk, to train 20 migrant workers and/or their family members in 5
years as advocates and to coordinate forums for migrant workers : LGU
4. Conduct HIV/AIDS prevention forum for migrant workers – yearly forums for five years targeting
migrant workers and families : LGU
5. Conduct monitoring and supervision – 2 supervisory visits per year in any of the 16 sites :
National/sub-national Department of Health (DOH) and Department of Labor and Employment
(DOLE)
Service Delivery Area: STI diagnosis and treatment
1.
Diagnose STI cases : SHC
2.
Procure STI diagnostic kits, supplies and equipments : PMO
3.
Manage STI cases: SHC
4.
Procure STI drugs : PMO
5.
Train SHC and private clinic counterparts on comprehensive STI diagnosis and management conducted in two batches, yearly for five years : DOH-NASPCP
6.
Conduct National STI convention – public –private partnership forum of MDs every two years :
private firm
7.
Conduct Local site coordination forum in 16 sites : members of Local AIDS Council (LAC),
SHC, VCT centers, HACT
48
8.
Conduct monitoring and supervision – 1 site per year : PMO, NASPCP, NEC, STD AIDS
Central Cooperative Laboratory (SACCL)
Service Delivery Area: Testing and Counseling
1.
Train staff on basic VCT – participants will be from DOH-central office, DOH sub-national
offices, regional hospitals, private hospitals and clinics and NGOs in 16 sites (90 personnel in
four batches conducted in first two years) : NASPCP
2.
Review and revise target specific BCC modules (PIP, migrant workers) - consultancy : NGO
3.
Review and revise target specific VCT modules (sex workers, MSM, migrant workers, youth,
workplace) – consultancy : NGO
4.
Implement quality assurance program for VCT centers – external quality assurance on years 2
and 4 : National Reference Laboratory (SACCL)
5.
Train local staff on target-specific VCT in 16 sites – SHC, NGO, Overseas Filipino Workers’
clinics (OFW), Pre-employment Service Office (PESO), City Health Office (CHO)
6.
Set up VCT rooms in SHC in 16 sites – renovation, furniture, provision of computer : PMO
7.
Set up VCT rooms in partner hospitals – renovation, provision of computer, furniture : PMO
8.
Provide voluntary counseling and testing and establish/operationalize linkages between VCT
and treatment centers- daily activity during office hours : SHC, hospitals Procurement of HIV
testing kits : PMO
9.
Promote VCT social marketing – targets migrant workers and the workplace, contracts out
services of a marketing firm to develop the scheme and implement : private sector
10. Conduct monitoring visits to improve reporting system– 2 visits in 2 randomly selected sites
per year : NASPCP
Service Delivery Area: PMTCT
1.
Develop national guidelines on PMTCT including provision of infant formula– workshop on
lessons learned and development of protocol : treatment hubs/NASPCP
2.
Develop training module – 1 for hospitals, 1 for antenatal clinics : NASPCP, treatment hubs
3.
Popularize and implement national guidelines - advocacy meetings : NASPCP
4.
Train staff on the implementation of PMTCT guidelines – 9 treatment hubs, 3 other identified
government hospitals and 2 private hospitals : NASPCP, San Lazaro hospital, RITM
5.
Provide PMTCT services in 8 treatment hubs – referral from VCT centers to PMTCT, provision
of ARV to mothers and infant formula for infants of HIV positive mothers : treatment hubs
Service Delivery Area: Information System (Surveillance and Operational Research)
1.
Conduct rapid assessment survey in 16 sites – baseline survey : NEC
2.
Conduct IHBSS in ten sentinel sites – integrated behavioral and serologic surveillance during
the first and 5th year, serves as evaluation tool for the Department of Health : NEC
3.
Conduct operational research – studies on factors that facilitates reaching OFW for VCT :
consultancy (academe)
4.
Conduct Sentinel STI Etiologic Surveillance System (SSESS) in 16 sites – includes training of
medical technologists on the laboratory diagnosis of 7 STI, training of encoders on the use of
SSESS software, submission of reports from the SHC and private clinic counterparts to subnational and NEC, meetings between SHC, private clinic physicians and NEC coordinator :
NEC
5.
Publish annual technical reports – technical report on the result of IHBSS (years 1 and 5) :
49
NEC
6.
Conduct national dissemination forum – dissemination of the results of IHBSS to Directors of
the national and sub-national DOH offices and stakeholders (years 1 and 5)
7.
Conduct Central planning – 1 day consultative workshop by surveillance coordinating body to
discuss issues on surveillance : NEC
8.
Conduct Management and Technical Review - two-day consultative workshop attended by
selected surveillance staff and national AIDS program manager : NEC
9.
Conduct Integrated Blood Bank Information System (IBBIS) – information system for the blood
program which will be linked to the National HIV/AIDS Registry : contracted out but still under
the Philippine Blood Center
10. Conduct Monitoring and Supervision – yearly monitoring of the conduct of surveillance, 5
randomly selected sites per year : NEC
Objective 2: Ensure safe blood supply
Service Delivery Area: BCC: mass media
1. Develop video materials for SHC and blood service facilities (BSF) – contracted out to develop
concept design, pre-testing and reproduction of video materials (focused on healthy lifestyle and
HIV/AIDS prevention) : NASPCP and NVBSP
2. Reproduce existing video materials for migrant workers – for distribution to OFW clinics : private
sector
3. Develop tri-media campaign materials and air time – contracted out to develop concept design
and schedule for air time during World AIDS Day and World Blood Donor Day : private sector
Service Delivery Area: BCC: community outreach (public education)
1. Conduct community forum on voluntary blood donation – focuses on healthy lifestyle and
HIV/AIDS prevention conducted every year : LGU
2. Train local blood recruiters – capacity building of volunteers to act as advocates for voluntary
blood donation and establish pool of volunteer blood donors : NVBSP
3. Reproduce and distribute IEC materials – pamphlets, posters, brochures : NVBSP
4. Revise, reproduce and distribute learning materials in primary and secondary schools –
workbook for children with focus on healthy lifestyle, benefits of blood donation and prevention
of HIV/AIDS : private sector
Service Delivery Area: Blood Safety
1. Test blood units for HIV and other Transfusion Transmissible Infections on 400,000 units of
blood including 100,000 in the first 2 years (TTI: syphilis, hepatitis B, Hepatitis C, HIV and
malaria) by the national and two sub-national blood centers and 12 regional blood centers :
Philippine Blood Centers
2. Upgrade blood cold chain system in the national, sub-national and regional blood centers –
BS/BCU procurement of platelet rotator and incubator, transport boxes during the first year of
project implementation : Philippine Blood Center
3. Train staff on blood cold chain management - years 2 and 3 trainings on blood cold chain
management : Philippine Blood Center
4. Strengthen national, sub-national and regional blood centers – procurement of motorcycles as
blood express, provision of gasoline allowance and hiring of drivers to collect blood units from
BS/BCU for centralized testing : PMO
50
5. Implement total quality management (TQM) - external quality assurance, trainings, audits :
Research Institute for Tropical Medicine (RITM)/ Philippine Blood Coordinating Council (PBCC)
6. Conduct training on rational use of blood in hospitals – development, reproduction and
distribution of Clinical Practice Guidelines (CPG), advocacy meetings and training on the use of
CPG contracted out to PBCC
7. Train staff on pre and post donation counseling – module development and training during the
first 3 years of project implementation on the use of module : contracted out to PBCC
8. Conduct monitoring and supervision – yearly monitoring in a randomly selected blood center :
NVBSP
Objective 3: Scale up treatment, care and support for PLWHAs, their families and significant
others
Service Delivery Area: ARV treatment and monitoring
1. Train HACT on the clinical management of HIV/AIDS, including ARV – government and private
hospitals : NASPCP
2. Develop marketing segmentation approach for ARV – contracted out to a private marketing firm
for development of mechanism and implementation during the 5 years project life
3. Enroll PLWHAs in social health insurance – payment of annual premium for 200 PLWHAs
based on guidelines set : Department of Health in collaboration with the Philippine Health
Insurance System
4. Provide ARV – will procure ARV for 200 PLWHAs on years 3 to 5 and take on enrolled
PLWHAs during the 3rd and 5th rounds of GF project and new enrollees for the 6th round :
NASPCP/treatment centers. ARV need for years 1 and 2 will be provided by the national ARV
program.
5. Provide care and support for health care providers of PLWHAs – debriefing sessions for health
care providers in the 8 treatment hubs : NASPCP
6. Monitor CD4 count and viral load of PLWHAs – provision for 134 PLWHAs based on guidelines
set : treatment hubs
Service Delivery Area: Prophylaxis and treatment of OI
1. Provide drugs for OI - procurement and provision of OI drugs to 100 PLWHAs with OI every
year: treatment hubs
2. Develop guidelines on the provision of prophylactic treatment and vaccines against influenza,
pneumococci and chicken pox - contracted out to a private firm
3. Provide vaccines and prophylactic treatment to fight against influenza, pneumococci and
chicken pox – targets 170 PLWHAs in 5 years project life : NASPCP
Service Delivery Area: Care and Support for the Chronically Ill
1. Conduct home visits – conducted in years 4 and 5 : NGO
2. Train PLWHAs on microentrepreneural skills – targets 20 PLWHAs with provision of seed
money per year in 5 years project life : NGO
3. Support PLWHAs during referrals to VCT and or treatment hubs – provision of transportation
and accommodation allowance to PLWHAs based on set guidelines : NASPCP
4. Train community workers on ARV adherence – 6 trainings on two batches a year from third to
fifth year : NASPCP
5. Conduct a national convention for PLWHAs – conducted annually for years 1 and 3
51
Service Delivery Area: Stigma reduction
1. Conduct stigma reduction activities – forums involving different key players : LGU, NGO, faith
based organizations
Objective 4: Strengthen health system to provide HIV/AIDS services
Service Delivery Area: Supportive environment: coordination and partnership development
1. Provide site implementation and coordination support – hiring of sub-national implementation
officers to assist sub-national DOH offices in coordinating all project activities in project sites,
reports to PMO, national, sub-national DOH coordinators and LGU : PMO
2. Conduct advocacy meetings with the Local AIDS Council and Local Blood Council – annually
conducted : DILG
Service Delivery Area: Supportive environment: strengthening of civil society and institutional
capacity building
1. Develop and popularize social health insurance package for STI, HIV, blood services –actuarial
study, framework design, stakeholders’ meetings : Philippine Health Insurance System
2. Conduct annual partners’ meeting - venue for project implementation review : DOH
3. Provide technical assistance to PMO staff and selected national, sub-national and local program
coordinators – technical assistance on areas of project management, procurement and supply
management, M&E, surveillance, VCT, PMTCT and other unprogrammed technical assistance:
multilateral or bilateral agency as sub-recipient
4. Conduct external evaluation – conducted before the end of second phase to institute corrective
measures if deemed necessary : multilateral or bilateral agency as sub-recipient
5. Conduct PMO monitoring and evaluation – two visits a year in 5 years in areas of project
implementation, finance, logistics: PMO
6. Conduct TWG and CCM meetings – TWG consist of selected stakeholders that has
recommendatory functions in project implementation, conducted every month, CCM meetings
conducted twice every quarter : PMO
7. Hire PR/PMO staff - 12 PMO staff with human resource package in 5 years : PMO
8. Provide insurance package for PMO staff and field staff – annually for five years : PMO
9. Procurement and supply management including contracting out freight forwarders – annually for
five years : PMO
10. Provide communication expenses for the PMO – communication expenses in carrying out
functions related to project implementation
52
4.6.4 Performance of and linkages to current Global Fund grant(s)
This section refers to any prior Global Fund grants for this disease component and requests information on
performance to date and linkages to this application. For more information, please refer to the Guidelines for
Proposals, section 4.6.4.
a) Provide an update of the current status of previous Global Fund grants for this disease
component, in the table below.
Table 4.6.4. Current Global Fund grants
Grant number
GF Grant 1
R3-PHL-304-G03-H
Grant amount* (USD)
Amount spent (USD)
5,528,825
3,053,529
1,488,980
0
Unsigned yet
GF Grant 2
(approved Phase 1 by
the TRP)
GF Grant 3
GF Grant 4
*
For grants in Phase 1, this is the original two year grant amount. For grants that have been renewed into
Phase 2, this is the total amount, inclusive of Phase 1 and Phase 2. For unsigned Round 5 grants this is the
two year TRP approved maximum budget.
b) Please identify for each current grant the key implementation challenges and how they have
been resolved.
One of the challenges during the initial phase of the GFATM -AIDS was the delayed procurement of ARV.
This was addressed by international bulk procurement to UNICEF. Another challenge was in the
monitoring and evaluation wherein sub-sub recipients (field implementers) were submitting more than
100% accomplishments for the indicators. The TWG had to meet and worked on the redefining of each
indicators. Another important challenge was the reporting system from the time of encoding to the time of
submission to the national level. At the social hygiene clinic level, staff were already overloaded with
mulit-tasks, Data encoding for the SSESS (surveillance, information and reporting system) has always
been least prioritized resulting to delayed reporting to the national level. A pre-existing system of
reporting from the field to the sub-national going to the national is in place. However, Phase 1
implementation of Round 3 required monthly submission of reports. To expedite this process, the national
offices often collect reports directly from the SHC by-passing the sub-national level which resulted to a
weak system of reporting.. Data , encoding happens at the national level which should not be the case..
Before the end of Phase 1,to strengthen the reporting system, training of trainers was done for the subnational staff to put them back into the loop of the reporting system. Other constraints noted were missing
out government staffs to implement major important activities like program monitoring and coordination
since sources of funds for government activities were not clear. There were sites that GFATM activities
were beyond the knowledge of the local mayors and provincial health officers, since most of the activities
in the field were NGO driven. The principal recipient took notice of this and before the end of the first
phase, an intensive monitoring activity was conducted together with a team from the Department of
Health and Department of Interior and Local Government from the national and sub-national offices.
Meetings with the local government executives and local health officers were done to discuss the GFATM
goals and objectives and solicited their commitments. Upon evaluation, catch –up trainings on STI
management, VCT and on-site advocacy on AIDS law and 100% CUP (condom use program) are all
being done before the beginning of the second phase of Round 3.
Yes
c) Are there any linkages between the current proposal and any existing
Global Fund grants for the same component? (e.g. same activities,
same targeted populations and/or the same geographical areas.)
Î complete d)
No
Î go to 4.6.5.
53
d) If yes, clearly list such linkages and describe how this proposal builds on, but is not duplicative of
the funding provided under current Global Fund grants.
Linkages between Rounds 3, 5 and 6 GFATM on HIV/AIDS
Site
Laoag City
Tuguegarao
Santiago
Angeles
Puerto Galera
Puerto Princesa
Iloilo City
Cebu City
Zamboanga City
Davao City
General Santos City
Butuan City
Cotabato City
Bauang, La Union
San Fernando, Pampanga
Gumaca, Quezon
San Pablo City
Legaspi City
Tabaco City
Sorosogon City
Matnog
Lapu-Lapu City
Mandaue City
Ormoc City
Baguio City
San Fernando, La Union
Lucena City
Daraga, Albay
Allen, Samar
Tacloban City
Kananga, Leyte
Isabel, Leyte
Surigao City
Batangas City
Bacolod City
Calbayog City
Catbalogan City
Cagayan de Oro City
Metro Manila (4 sites)
GF
Round
VCT,
BCC, STI
Blood
Services
6
6
6
6
6
6
6
6
6
6
6
6
R6
R6
R6
R6
R6
R6
R6
R6
R6
R6
R6
R6
3
3
3
3
3
3
3
3
3
3
3
5
5
5
5
5
5
5
5
5
5
5
5
5
5
5 and 6
R3
R3
R3
R3
R3
R3
R3
R3
R3
R3
R3
R5
R5
R5
R5
R5
R5
R5
R5
R5
R5
R5
R5
R5
R5
R5
R6
R6
R6
R6
R6
R6
R6
R6
R6
R6
R6
R6
R6
R6
R6
R6
Treatment
Center/s
IDU
Intervention
(HRP)
R6
R6
R6
R3
R3
R5
R3
R5
R5
R3
R3
R6
R6
IHBSS
R6
R6
R6
R6
R6
R3
R3
R3
R3
R3
R3
R3
R3
R3
R3
R3
R6
R3
R6
R6
R6
R6
R3 (3
hospitals)
R5
R6
R6
Rounds 3 and 5 prevention efforts were both focused on reaching out to the most at risk and vulnerable
populations, round 6 proposal will complement the two projects with scaling up prevention efforts in both
the MARP and the general population in every level of the health systems. At the community level, local
health facilities through the 16 SHC and regional medical centers will be enhanced to cater to the growing
demands for HIV and STI services. This will be complemented by blood safety activities like mass media
and public education focused on the healthy lifestyle and HIV/AIDS prevention. This strategy will establish
the link between VCT, blood program and treatment, care and support services. However, the blood
program has additional seven sites where HIV prevention efforts are already existing through rounds 3
and 5. These are: Baguio City, San Fernando, La Union, Bauang, La Union, Batangas City, Legaspi City,
Tacloban City and Cagayan de Oro City (see table above).
ARV request for round 6 will be done during the phase II implementation. Phase I ARV requirement will
be requested from the available ARV of rounds 3 and 5.The design of the GF ARV provision is towards
fulfillment of a nationally coordinated ARV program.
54
GFATM AIDS
Project Sites
Round 3- Prevention Sites
Round 3 & 5 - Care Support Sites
Round 3 & 5 - IDU sites only
Round 5 – Prevention Site
Round 6 – Proposed Prevention
Sites
55
4.6.5 Linkages to other donor funded programs
Yes
a) Are there any linkages between the current proposal and any other
donor funded programs for the same disease
Î complete b)
No
Î go to 4.6.6.
b) If yes, clearly list such linkages and describe how this proposal builds on, but is not duplicative of
the funding provided by other donors, including in respect of health system strengthening
activities.
List of Current HIV and HIV Related Project Sites, March 2006
Region
CAR
*LEAD
Baguio
Ilocos
Cagayan Valley
Central Luzon
Metro Manila
WHO
UNICEF
Urdaneta
Dagupan
San
Fernando
City
Laoag
Angeles
San
Fernando,
Pampanga
Pasay,
Quezon City
Manila
Pasay
Quezon
City
UN Habitat
Olongapo
Munoz
San Jose,
del Monte
Marikina
Muntinlupa
Pasay
Manila
Gumaca
San Pablo
City
MIMAROPA
Bicol
Camarines
Norte
W.Visayas
Iloilo
C.Visayas
Cebu
Davao
SOCSKSARGEN
UNFPA
Mt. Province
Ifugao
Bauang
San
Fernando,
L.U.
CALABARZON
E.Visayas
Zamboanga
Peninsula
N. Mindanao
**GFATM
Baguio City
Negros
Occidental
Zamboanga
Dipolog
Cagayan de
Oro
Malay
Balay,
Valencia
Davao City
Gen. Santos
CARAGA
ARMM
Guimaras
Iloilo
Negros
Oriental
Antipolo
Tagaytay
Legaspi
Tabaco
Sorsogon
Matnog
Masbate
Sorsogon
Naga
Lapu-lapu
Mandaue
Ormoc
Bohol
Cebu
E. Samar
Mandaue
Calbayog
Iligan
Davao City
Davao City
Sultan
Kudarat
Samal
Butuan
Maguindanao
Sulu
Tawi-Tawi
Lanao del
Sur
56
*LEAD: under the USAID funding has just ended (2005). Round 6 will strengthen the HIV/AIDS
prevention efforts through intensified VCT, STI diagnosis and treatment, mass media, public education,
blood safety services, referral system and surveillance. These sites have been the sentinel sites since
1993 where potential HIV epidemic might occur considering the number of HIV positives detected in each
surveillance rounds and the risk behavior practices in the areas.
WHO: these are the pilot and expansion sites of the 100% Condom Use Program. Only Laoag City will be
covered by Round 6 GFATM, on the basis of site vulnerability because of urbanization, migration and
tourism.
UNICEF: community focused intervention among children, youth and pregnant mothers; started pilot
testing VCT strategies in two cities; funding support in pilot testing new protocol of the National HIV/AIDS
Registry in Cebu, Davao, Manila, Pasay and Quezon City; Round 6 will be implementing HIV/AIDS
prevention activities in Davao and Iloilo Cities. Also, in the round 6 proposal, Davao Medical Center, a
sub-national blood center will be strengthened through the Global Fund. Likewise, another treatment
Center will be developed in Iloilo City.
**GFATM: round 6 sites will not cover previous GF sites except the 7 blood program areas (please see
4.6.4 d)
UNFPA: focused on community organization, advocacy work, policy development and program support
for PLWHA organization. Among UNFPA’s sites, only Davao City will be covered by round 6.
UN Habitat: this is under the auspices of the UNDP, which uses the platform of the Millennium
Development Goals. Capacity strengthening of local governments including the local chief executives on
policies and programs related to the prevention, treatment and care of HIV.
4.6.6 Activities to strengthen health systems
Certain activities to strengthen health systems may be necessary in order for the proposal to be successful and
to initiate additional HIV/AIDS, tuberculosis, and/or malaria interventions. Similarly, such activities may be
necessary to achieve and sustain scale-up.
Applicants should apply for funding in respect of such activities by integrating these within the specific disease
component(s). Applicants who have identified in section 4.4.4 health system constraints to achieving and
sustaining scale-up of HIV/AIDS, tuberculosis and/or malaria interventions, but do not presently have adequate
means to fully address these constraints, are encouraged to complete this section. For more information,
please refer to the Guidelines for Proposals, section 4.6.6.
a) Describe which health systems strengthening activities are included in the proposal, and how
they are linked to the disease component. (In order to demonstrate this link, applicants should relate
proposed health systems interventions to disease specific goals and their impact indicators. See the MultiAgency M&E Toolkit.)
GOAL 1: To maintain a less than 1% HIV prevalence by scaling up VCT and ensuring safe blood
supply
Impact Indicator: Maintaining a less than 1% HIV prevalence
Health System Strengthening:
Service Delivery: SHC, hospitals in 16 GF sites providing VCT according to national guidelines,
SHC, hospitals, blood service facilities regularly supervised according to national standards, SHC and
private clinic partners with complete capacity and supplies to diagnose HIV, HIV tests done in VCT
centers
Human Resources: SHC, sub-national DOH offices with staff complementation from the Global
Fund, health workers at all levels trained on BCC, STI, VCT, clinical management on HIV/AIDS,
SSESS, cold chain management system, rational use of blood, pre and post donation counseling,
surveillance
Community Systems strengthening: Local Blood Council, trained community workers on
recruitment of volunteer blood donors, trained peer educators on HIV/AIDS prevention package,
trained community workers on ARV adherence
Information System and Operational Research: conduct of IHBSS in ten sentinel sites,
57
implementation of IBBIS, timely submission of SSESS reports by SHC in 16 sites, conduct of
operational research on OFW in three pilot sites
Infrastructure: setting up of VCT areas in SHC and hospitals in 16 sites
Procurement and Supply Management: capacity building of PMO on procurement, supply and
management
Health System Financing: social marketing for VCT
National Health Policies: policy development for newly developed national guidelines on VCT,
PMTCT
GOAL 2: To reduce the impact of HIV/AIDS among PLWHAs, their families and significant others
Impact Indicator: Adults and children with HIV still alive 12 months after initiation of ARV
Health System Strengthening:
Service Delivery: treatment hubs providing ARV, drugs for opportunistic infections and vaccines
against other infectious diseases, treatment hubs monitoring CD4 and viral load of PLWHAs, PMO
staff conducting supervisory visits based on national guidelines
Human Resources: PMO staff fully equipped on project implementation
Community Systems strengthening: functional Local AIDS Council and Local Blood Council,
trained community workers on ARV adherence
Infrastructure: establishment of additional treatment centers in Western Visayas and Cagayan
Valley
Health System Financing: health insurance package for PLWHAs, livelihood program for PLWHA,
social marketing for ARV
National Health Policies: policy development for Local AIDS Council
b) Explain why the proposed health systems strengthening activities are necessary to improve
coverage to reduce the impact and spread of the disease and sustain interventions.
(When completing this section, applicants should refer to the Guidelines for Proposals, section 4.6.6.)
The proposed health systems strengthening will provide more facilities for an equitable and more
accessible delivery of quality services that are sustainable and less burdensome to clienteles through
health insurance packages and social marketing. A less stigmatized environment through mass media
and public education backed up by strong leadership from the Department of Health and local
government units with support from the civil society opens the door for access of more PLWHAs and
vulnerable population.
c) Describe how activities to strengthen health systems, integrated within this component, will have
positive system-wide effects and how it is designed in compliance with the surrounding context
and aligned with government policies.
Major strategy of the proposal is to strengthen the Philippine Health System towards the attainment of
universal access to HIV/AIDS prevention, treatment, care and support that is built upon the four pillars of
health sector reform agenda: good governance, service delivery, health care financing and regulations.
Through these pillars, the Department of Health will lead in the delivery of quality, humane services that
will encourage and inspire the previously stigmatized/marginalized segment of the population and forge
partnerships with the private sectors/civil society.
System strengthening in this proposal takes into consideration four quadrants of health care delivery:
primary, secondary, tertiary and rehabilitation. In all these quadrants, interventions are readily available
either at the community level or at the facility level.
(Annex 11.1 Framework for DOH Health Delivery System for HIV/AIDS)
58
Yes
d) Are there cross-cutting health systems strengthening activities
integrated within this component that will benefit any other component
included in this proposal?
Î complete e) and f)
No
Î go to g)
e) If you answered yes for d), describe these activities and the associated budgets and identify and
explain how the other components will benefit. Please refer to the Round 6 HSS Information Sheet on
http://www.theglobalfund.org/en/apply/call6/documents/ before completing this section.
f) If you answered yes for d), confirm that funding for these activities has not also been requested
within the other component. Please refer to the Round 6 HSS Information Sheet on
Yes
g) Is this component reliant on any cross-cutting health systems
strengthening activities that have been included within other
components of this proposal?
Î complete h)
No
Î go to 4.6.7.
h) If you answered yes for g), describe these activities and the associated budgets and identify and
explain how this component will benefit. Please refer to the Round 6 HSS Information Sheet on
4.6.7 Common funding mechanisms
This section seeks information on funding requested in this proposal that is intended to be contributed through
a common funding mechanism (such as Sector-Wide Approaches (SWAp), or pooled funding (whether at a
national, sub-national or sector level).
Yes
a) Is part or all of the funding requested for the disease component
intended to be contributed through a common funding mechanism?
Î answer questions below.
No
Î go to 4.8
b) Indicate in respect of each year for which funds are requested the amount to be funded through
a common funding mechanism.
c) Describe the common funding mechanism, whether it is already operational and the way it
functions. Identify development partners who are part of the common funding mechanism.
Please also provide documents that describe the functioning of the mechanism as an annex.
(This may include: The agreement between contributing parties; joint Monitoring and Evaluation
procedures, management details, joint review and accountability procedures, etc.)
59
d) Describe the process of oversight for the common funding mechanism and how the CCM will
participate in this process.
e) Provide an assessment of the incremental impact on projected targets as a consequence of the
funds being requested for this component, which are to be contributed through the common
funding mechanism.
f) Explain the process by which the applicant will ensure that funds requested in this application,
that are contributed to a common finding mechanism, will be used specifically as proposed in this
application.
4.6.8 Target groups
Provide a description of the target groups, and their inclusion during planning, implementation and
evaluation of the proposal. Describe the impact that the program will have on these group(s).
Target Groups:
Most at Risk Population (MARP): These are the major clients of the Social Hygiene Clinics (SHC).
Most of these are establishment based female sex workers who seek STI/HIV prevention services.
MSM and clients of sex workers and freelance female sex workers are also the target population of
the proposal. During proposal development selected leaders of NGOs working on the mentioned
target population were actively involved during the consultative workshops. It has been stipulated in
the proposal that peer educators will be trained and empowered to provide BCC and counseling
services at the SHC.
Migrant Workers: These are the migrant workers either on vacation or had previous employment
outside the country. Based on the National HIV/AIDS Registry, around 35% of the reported HIV
positive cases belong to this group. They were not involved during proposal development but the
project will tap local pre-employment service officer in each site to man the migrant workers’ desk.
The officer will be in charge of IEC distribution and coordinate community forum. The proposal will
empower migrant workers and their families as advocates through intensive trainings.
General Population:
Facility based VCT, SHC, private clinic clients
High risk pregnant mothers
Community/villagers
Blood donors
They were not involved during the proposal development but they were represented by key people
working on each specialty areas. Forums will be spearheaded by community leaders. As regards
the blood donors, there will be trainings that will be provided for the community who will be
advocates in voluntary blood donation, healthy lifestyle and HIV/AIDS prevention. A pool of
voluntary blood donors will also be formed in the villages through these trained advocates.
People Living with HIV/AIDS (PLWHAs):
PLWHA groups were invited during proposal development and have involved themselves actively
during the workshops. During the implementation of the care and support component, they will be
partner implementors of the Department of Health and local government units (LGU).
Program Impact:
MARP: through the BCC given at the SHC, it will be expected that they will develop skills in condom
60
negotiation, increased awareness on HIV/AIDS, increased access to counseling and testing and
empowered to get HIV test results and decreased episodes of STI
Migrant Workers: increased awareness on HIV/AIDS and its prevention, increased access to
voluntary counseling, testing and obtaining their results
General Population: increased awareness on HIV/AIDS, prevention and available services
High risk mothers: referral from Voluntary counseling and testing services (VCT) to PMTCT;
prevention of mother to child transmission
Blood Donors: increased awareness on voluntary blood donation and HIV /AIDS prevention and
practices healthy lifestyle
PLWHAs: quality of life, decreased stigma, increased involvement in social functions
4.6.9 Social stratification
Provide estimates of how many of those expected to be reached are women, how many are youth,
how many are living in rural areas and other relevant categories. The estimates must be based on a
serious assessment of each objective.
Table 4.6.9 Social stratification
Estimated number and percentage of people reached who are:
Women
Youth (<18)
Living in rural areas
60% (15,569)
20% (5,189)
40% (10,380)
60% (16,984)
<20% (2,831)
50% (14,154)
40% (5,692)
10% (1,4230)
20% (2,460)
100% (25)
As need arise
40% (10)
50% (12,975)
10% (2,595)
40% (10,380)
60% (1,200,000)
25% (500,000)
>50% (1,000,000)
>60% (1,656)
>40% (1,104)
>60% (1,656)
<25% (100,000)
>50% (200,000)
50% (200,000)
Objective 3: SDA 1: Treatment
Antiretroviral treatment (ARV) and
monitoring
50% (100)
no estimate for
children
and youth
50% (100)
Objective 3: SDA 2: Treatment
Prophylaxis and treatment for OI
50% (84)
no estimate for
children
and youth
<40% (67)
Objective 4: SDA 1: Care and
support for the chronically ill
50% (50)
no estimate for
children
and youth
50% (50)
60% (4,800)
30% (2,400)
60% (4,800)
Objective 1: SDA 1: Prevention
BCC - community outreach
STI diagnosis and treatment
Testing and Counseling
PMTCT
Objective 1: SDA 5: Information
system & OR
BCC - Mass media
BCC - community outreach
Blood safety
Objective 3: SDA \
\2: Supportive environment:
Stigma reduction activities
Other*
61
SDA 13: Supportive environment:
Coordination and partnership
development(
50% (1,000)
25% (500)
50% (1,000)
SDA 14: Supportive environment:
Strengthening of civil society and
institutional capacity building (5
pax/org)
50% (63)
<10% (5)
50% (63)
*
Other” to include target groups according to country setting, e.g. indigenous populations, ethnic groups,
underprivileged regions, socio-economic status, etc. Targets should be defined according to country disease
programs.
4.6.10 Gender issues
Describe gender and other social inequities regarding program implementation and access to the
services to be delivered and how this proposal will contribute to minimizing these gender inequities.
All service facilities for HIV prevention particularly STI management, VCT, access to treatment hubs will be
open to all clients irrespective of gender, age and race group. Although most of the social hygiene clinics
cater to registered female sex workers, a lot of SHCs has expanded their reach to cover reproductive
health services (some SHC have been renamed Reproductive and RTI Clinic). In addition, establishing
VCT services within the SHC will be the entry point for male and female clienteles for referral to services
being offered by the SHC and its partner hospital facilities. Most likely because both the VCT and SHC
personnel will be trained, treatment and referral will be enhanced to cater to the needs of both gender.
During program implementation gender based and rights based approaches will b integrated in each
orientation and trainings including careful review of modules for development to correct gender biases and
discriminations.
4.6.11 Stigma and discrimination
Describe how this component will contribute to reducing stigma and discrimination against people
living with HIV/AIDS, tuberculosis and/or malaria, as applicable, and other types of stigma and
discrimination that facilitate the spread of these diseases.
The proposal covers activities that will enhance a supportive environment for the PLWHAs. At the
community level, dialogues and symposia will be organized by local government units, faith based
organizations, private sector and NGOs to reduce stigma and discrimination against the PLWHAs. Facility
(hospital) based seminars will be conducted to mainstream HIV service provision for HIV patients in order
to address the problem of discrimination among health personnel at the health facility level. The design
for increasing awareness through the mass media will be carefully studied to target specific issues that
will promote the accepting attitudes of communities to PLWHAs.
4.6.12 Equity
Describe how principles of equity will be ensured in the selection of patients to access services,
particularly if the proposal includes services that will only reach a proportion of the population in
need (e.g., some antiretroviral therapy programs).
Prevention activities will target the most at risk and adult population of the general population. Specific
health service delivery package designed for the most at risk will be through the SHC and outreach
clinics, which are public facilities where most of the poor seek health and treatment services.
For ARV treatment, DOH has issued Memorandum Circular No. 2006-0026 creating the guidelines in
accessing and utilization of ARVs for PLWHAs. All patients needing ARV based on the clinical
management guidelines of the WHO (adopted by the DOH) can avail of the ARV for free from any of the
six government treatment centers. Guidelines will likewise be set by the DOH for equitable access on
vaccines for infectious agents and OI drugs. Provision of benefit package by the Social Health Insurance
for PLWHAs will facilitate the equitable utilization of HIV related services. For the institutionalization of
social marketing strategies for VCT, assessment of the individual’s ability to pay will be done through the
62
hospital or the local social welfare offices.
(Annex 21 Access to ARV in Government Treatment Centers)
4.6.13 Sustainability
Describe how the activities initiated and/or expanded by this proposal will be sustained at the end of
the program term. (When completing this section, applicants should refer to the Guidelines for Proposals,
section 4.6.13.)
Appropriate social marketing strategies for VCT and blood services are part of the proposal. VCT services
will be marketed to other populations including migrant workers and the workplace. This is to cover for the
sustained operation even after the Project has ended and provide some subsidy for those who cannot
pay for the services. Social Workers are available at the local governments and hospitals to assess the
capacity to pay. The national health insurance program is implementing blood services re-imbursement
scheme while the HIV/AIDS benefit package is under development as endorsed by the Secretary of
Health. Specific activities under the SDA on blood safety such as the Integrated Blood Bank Information
System (IBBIS) was designed to have a return of investment on Years 4 and 5 through subscription fees
from public and private blood bank facilities. NVBSP has allowed a cost recovery mechanism using the
maximum allowable blood service fee for blood and blood products, which is pegged at Whole Blood =
Php 1,500; Packed RBC = Php 1,100; other blood products = Php 700.00.
The Department Budget and Management (DBM) and the Department of Interior and Local Government
(DILG) issued a separate Memorandum to Local Government Units enjoining the funding of MDG related
activities including HIV/AIDS and inclusion of voluntary blood donation services in the LGU work and
financial plan respectively. Since 2005, the local government is receiving the 100% of their Internal
Revenue Allotment while the national government has a 24% increase in its health spending from 2003 to
2004 (PNHA 2004), which could be a significant source of financing for the sustainability of the
interventions.
HIV and AIDS prevention efforts under this proposal are facility based through the social hygiene clinics
or the local health employment offices. This is to ensure that the local governments can learn the
technology and it will be much easier for the local government to sustain the intervention once the project
ends. Institutional capacity building which covers training of personnel, facility improvement and systems
(referral) strengthening supported by the Project is designed to sustain the local and national responses.
The Philippine National AIDS Council is working towards strengthening coordination of the national multisectoral body down to the level of the sub national and the local government units through the Local AIDS
Council. Department of Health will provide technical leadership and support to the response through the
National AIDS/STI Prevention and Control Program (NASPCP).
4.7 Principal Recipient information
In this section, applicants should describe their proposed implementation arrangements, including nominating
Principal Recipient(s). See the Guidelines for Proposals, section 4.7, for more information. Where the applicant is
a Regional Organization or a Non-CCM, the term ‘Principal Recipient’ should be read as implementing
organization.
4.7.1 Principal Recipient information
Every component of your proposal can have one or several Principal Recipients. In table 4.7.1 below, you must
nominate the Principal Recipient(s) proposed for this component.
Table 4.7.1: Nominated Principal Recipient(s
Indicate whether implementation will be managed through a single
Principal Recipient or multiple Principal Recipients.
Single
Multiple
63
Responsibility for implementation
Nominated Principal
Recipient(s)
Area of responsibility
Contact person
Address, telephone, fax
numbers and e-mail
address
National Center for Disease
Prevention and Control
HIV/AIDS Component
Dr. Yolanda Oliveros
Director IV
Bldg. 13, DOH Compound,
Rizal Avenue, Sta. Cruz,
Manila, 1003, Philippines
(63 2) 711-6808 (Telefax)
[email protected];
[email protected];
4.8 Program and financial management
4.8.1 Management approach
Describe the proposed approach of management with respect to planning, implementation and
monitoring the program. Explain the rationale behind the proposed arrangements.
(Outline management arrangements, roles and responsibilities between partners, the nominated Principal
Recipient(s) and the CCM. Maximum of half a page.)
Since the Department of Health (DOH) will take on the role of Principal Recipient in this proposal, a
Project Management Office (PMO) will be created within the DOH. This will be headed by a Project
Manager who will be directly accountable to the Secretary of Health and to the Executive Committee
composed of undersecretaries, assistant secretaries of Health and director of the National AIDS/STD
Prevention and Control Program (NASPCP). PMO will have three units: technical, administrative and
M&E. There will be three technical officers who will take handle prevention program, treatment, care and
support, blood program and M&E. This is to complement the permanent staff of the DOH. PMO will be
directly collaborating with the DOH offices, particularly National AIDS/STD Prevention and Control
Program, National Voluntary Blood Services program, National Epidemiology Center and the treatment
centers. An Administrative unit will be established to provide administrative support to the Project
Manager and the technical officers. Headed by an administrative officer, the unit will be responsible for
the financial, supplies and logistics functions of the PMO. An M&E unit will also be established. This unit
is headed by an epidemiologist and supported by informatics officer, surveillance officer and clerk. This
will be responsible in harmonizing all project reports coming from the field as well as the financial and
logistics report within the PMO. PMO staff will be working closely with mandated offices within the DOH
such as Finance, Procurement and Legal Services, Material Management Division and the Bureau of
International Health Cooperation.
AIDS Project Coordinating Group is a body within the DOH that coordinates the existing HIV and AIDS
related Projects. It is Chaired and Co Chaired by NCDPC and the National Epidemiology Center (NEC)
respectively. This will be the venue for discussion of issues relating to implementation of foreign assisted
projects and oversee the alignment of the each project deliverables in the National Objectives for Health
and the Fourth AIDS Medium Term Plan of the country.
Technical Working Group is the working arm of the Country Coordinating Mechanism. It has a
recommendatory function to the CCM and composed of multi-sectoral memberships including
representations from people living with HIV. CCM monitors the implementation of the Project and
approves all reports before submission to GFATM.
64
Please note that if there are multiple Principal Recipients, section 4.8.2 below has to be repeated for each one.
4.8.2 Principal Recipient capacities
a) Describe the relevant technical, managerial and financial capacities for each nominated Principal
Recipient. Please also discuss any anticipated shortcomings that these arrangements might have
and how they will be addressed, please refer to any assessments of the PR(s) undertaken either
for the Global Fund or other donors (e.g., capacity-building, staffing and training requirements,
etc.).
The Department of Health spearheads the national program on HIV/AIDS. It sets direction for the other
partner agencies, either international, national, sub-national and local. The DOH is composed of offices
working harmoniously towards HIV prevention. These offices are manned by experts in their own fields,
namely, public health specialists, epidemiologists, laboratory experts and clinicians.
DOH has proven its managerial and leadership skills from the several development projects in the past. In
2000, Bureau of International Health and Cooperation was formed primarily devoted to handle and prepare
the grant negotiations and coordinates with international partners. In DOH Finance Service, a specified
unit is purely devoted to Foreign Assisted Projects (FAPs) with staff complement of five personnel. Reorganizations within the Procurement Service is on-going as a result of the implementation of Republic Act
9184 also known as the Government Procurement Reform Act and several management information
systems is being developed to better track the performance of each Projects.
Special guidelines issued by the Commission of Audit has paved the way for the creation of Trust Fund
Account for individual donor assisted Projects. In the past, delays have been experienced from the
issuance of cash availability from the Department of Budget and Management (DBM). Under the special
arrangement, DOH will manage the Trust Account under the name of the Project using the Global fund
proposal supported by the COA approved mechanism based on the existing auditing rules and
regulations. Disbursement requested by the PMO will be authorized by the Finance Director of the Finance
Service.
During the implementation, in anticipation of additional financing and logistics related activities within the
DOH system, additional staff will be hired to assist the Finance service in the preparation of specific
project reports of the Global Fund including attachment preparations. Computer equipment for finance,
procurement and supply management offices is likewise needed for timely preparation of reports.
Technical assistance for financial and procurement management, project monitoring and evaluation will be
needed to upgrade the capacity of existing staff.
b) Has the nominated Principal Recipient previously administered a
Global Fund grant?
c) Is the nominated PR currently implementing a large program funded
by the Global Fund, or another donor?
Yes
No
Yes
No
d) If you answered yes for b) or c), provide the total cost of the project and describe the performance
of the nominated Principal Recipient in administering previous grants (Global Fund or other
donor).
The DOH is presently managing loans and grants from various financial institutions. Loans and grants
management includes the preparation of withdrawal applications, preparation of statement of expenditures
(SOEs),; and other related reports as required by the international Financing Institutions (IFIs) and other
government agencies; and coordination with the IFIs and other agencies.
The Table below provides the Foreign assisted projects being managed by the DOH Finance Service and
its performance:
65
DEPARTMENT OF HEALTH
FOREIGN ASSISTED PROJECTS-ON GOING PROJECTS
STATUS OF ALLOTMENT , OBLIGATIONS & BALANCES
as of June 30, 2006
Projects
Funding
Mode
Agency
Health Sector Reform Project
(HSRP)
WB
Grant
Total
Project
Proj. Amt.
Life
$
1,032,100
3/19/02 to
6/30/06
MOOE
Cont. Allotment
LP
Allotment Received (2006)
GOP
LP
1,119,937
WB
Grant
$
200,000
GOP
LP
1,525,782
1,119,937
Social Dev't. Fund Grant for
Prevention and Control of SARS
Total Available Allotment
0
1,525,782
0
(676,000)
CO
CO
WB
Loan
$
16,000,000
0
0
2,048,412
2,048,412
0
GOP
597,307
0
Final Closin
2006.
Deadline fo
Bank
0
0
is on Sept.
597,307
0
676,000
1,754,573
0
492,148
2,676,691
16,250
659,750
3,844,839
0
7,028,82
0
7,843,244
7,028,820
9,400,000
2,600,00
0
9,400,000
2,600,000
17,243,244
9,628,82
0
17,243,244
9,628,820
3,336,441
0
508,398
0
-
-
2,996,948
-
2,996,948
-
4,846,297
4,031,872
Request for
-
9,400,000
2,600,000
Allotment w
14,246,297
6,631,872
-
12/28/05 to
6/30/2012
NCA for Lo
was alread
-
WHO
2,645,719
7,843,244
MOOE
WHO Regular Biennium Trust
0
LP
1/10/05 to
6/30/2011
MOOE
Second Women's Health and
Safe Motherhood Project
(2WHSMP)
0
0
3,168,839
676,000
2,090,266
$
13,000,000
2,645,719
GOP
1,754,573
Re-allignment
Loan
LP
Closing date
2,090,266
ADB
GOP
Re
Balance
12/7/04 to
7/25/07
MOOE
Health Sector Development
Project (HSDP)
Obligations
-
17,828,565
2,171,435
17,828,565
2,171,435
3,671,871
362,825
14,156,694
1,808,610
17,828,565
2,171,435
17,828,565
2,171,435
3,671,871
362,825
14,156,694
1,808,610
Trust
C-3rd Release
510,000
510,000
0
510,000
-Transferred
liquidation r
D-4th Release
80,600
80,600
0
80,600
No Dis
66
United Nation Population Fund
(UNFPA)-6th
UNDP
Rotavirus
Vac. Prog.
LLL of Path
(Proj. for
Appro.
Tech.in
Health
Rotavirus
0
0
590,600
797,657
0
2,444,945
797,657
0
2,444,945
0
6th Country Program for
Children
AUSAID
UNICEF
0
590,600
0
3,242,602
0
404,939
2,837,663
3,242,602
0
2,837,663
0
Project is on
404,939
0
Balance rep
the Dollar a
Dec. 31, 20
Trust
Mode
Agency
Avian & Pandemic Influenza
Preparedness
0
Project life -
1,020,498
1,020,498
Funding
0
Trust
1,020,498
Projects
590,600
Total
Project
Proj. Amt.
Life
0
Cont. Allotment
LP
0
0
Allotment Received (2006)
GOP
LP
952,254
1,020,498
0
952,254
Total Available Allotment
GOP
LP
68,244
0
Obligations
GOP
LP
68,244
0
Re
Balance
GOP
LP
GOP
Trust fund t
2006.
Trust
7,773,028
7,773,028
7,773,028
7,773,028
7,773,028
7,773,028
463,200
463,200
No Disburse
Trust
Activities ar
MARE/2006-064
MARE/2006-095
685,080
0
Sub-Total of On-Going FAPs
22,271,601
0
9,628,82
0
685,080
1,148,280
33,065,773
75,662
0
2,171,435
287,810
1,148,280
55,337,374
387,538
0
11,800,255
67
397,270
363,472
16,207,061
0
362,825
784,808
39,130,313
0
8,440,482
e) If you answered yes for b) or c), describe how the PR would be able to absorb the additional work
and funds generated by this proposal.
Some existing grants or loans are already nearing completion (ECDP, RW3, SEMP2 and ICHSP). In the
past much bigger amounts have been managed by the DOH. The Foreign Assisted Project Unit of the
Finance Service has 5 staff directly supervised by the Chief of the Accounting Division. The Division is
further supervised by a Director IV and an Assistant Secretary of Health. The Global Fund Project will hire
its Finance Officer and assistant under the Project Management Office to facilitate orderly and the timely
disbursement, liquidation and financial reporting to the Commission on Audit, Local Financing Agency and
to the Global Fund. Additional systems improvement mechanisms will be provided in the form of technical
assistance specific offices within the DOH for a more effective management. This early, the procurement
and logistics has underwent thorough review from European Union funded assessment, presently being
assessed by the Global drug Facility and is scheduled to be given technical assistance support from the
UNICEF in handling HIV related procurements and supply management at the national and local
government level.
4.8.3 Sub-Recipient information
Yes
Î complete the rest of
a) Are sub-recipients expected to play a role in the program?
4.8.3
No
Î go to 4.9
1–5
b) How many sub-recipients will or are expected to be involved in the
implementation?
6 – 20
21 – 50
more then 50
Yes
Î complete 4.8.3. d) -e)
c) Have the sub-recipients already been identified?
and then go to 4.9
No
Î go to 4.8.3. f) – g)
d) Describe the process by which sub-recipients were selected and the criteria that were applied in
the selection process (e.g., open bid, restricted tender, etc.).
e) Where sub-recipients applied to the Coordinating Mechanism, but were not selected, provide the
name and type of all organizations not selected, the proposed budget amount and reasons for
non-selection in an annex to the proposal.
f) Describe why sub-recipients were not selected prior to submission of the proposal.
The sub recipient for Technical Assistance has not been decided upon by the CCM as of the approval of
the proposal for endorsement to the Global Fund. The CCM will decide on the selection once the
proposal gets approval from the TRP.
68
g) Describe the process that will be used to select sub-recipients if the proposal is approved,
including the criteria that will be applied in the selection process.
Implementing offices within the DOH is expected to play an important role during the Project
implementation. National AIDS STD Prevention and Control Program (NASPCP) for VCT and Social
Hygiene Clinic component, National Epidemiology Center (NEC) for the baseline gathering and
surveillance, and the National Voluntary Blood Donation Program (NVBSP) and Philippine Blood Center
(PBC) for the blood program component. The matter will be decided by the CCM once the proposal was
approved.
The Sub Recipient for Technical Assistance will be decided by the CCM in a transparent manner. The
process implemented in the previous Rounds for the selection of the PR and SR shall be used in the
selection for SR for Round 6. Selection will be done through open nominations from the members of the
CCM and subsequent secret balloting by all member agency of the CCM.
4.9 Monitoring and evaluation
The Global Fund encourages the development of nationally owned monitoring and evaluation plans and
monitoring and evaluation systems, and the use of these systems to report on grant program results. By
completing the section below, applicants should clarify how and in what way monitoring the implementation of the
grant relates to existing data-collection efforts.
4.9.1 Plans for monitoring and evaluation
Describe how the targets and activities indicated in the Targets and Indicator Table (attached as
Attachment A to this proposal, see section 4.6) will be monitored and evaluated. Please identify any
surveys to which this proposal is contributing.
Monitoring and evaluation is an essential component of program implementation. The proposal clearly
shows how each activity will be monitored and reported. Inherent to the function of each agency in the
Department of Health is a quality assurance program: coordinators in each respective field at the
national, sub-national and local levels have their monitoring tool to guide them on the performance and
accomplishments to be able to institute necessary corrections the soonest possible time, if needed.
Quarterly, biannual or annual supervisory visit is scheduled for each activity in each service delivery area
by the national and sub-national coordinators. Local level monitoring is also done by field point persons
on a per activity basis and reported to the principal recipient following the existing reporting system. An
annual management and technical review will be conducted at the national level participated in by key
implementers to review program implementation and develop plans for the succeeding year using the
experiences and lessons learned in the previous year. Integrated HIV and Behavioral Surveillance will be
done in the first and last year of Project implementation, which will cover the major program outcome and
impact indicators. An external evaluation will also be done before the end of the first phase to elicit
information on the prospects, challenges and best practices that has been developed by the Project.
Likewise, monitoring and evaluation will also be done by the PMO of the Department of Health as
principal recipient to look at the aspects of program management, finance and supply distribution and
management. This will also entail PMO and CCM representative field visits and regular records review.
4.9.2 Integration with national M&E Plan
Describe how performance measurement for this program is proposed to contribute to and/or
strengthen the national Monitoring and Evaluation Plan for this component. If a national Monitoring
and Evaluation strategy exists, please attach it as an annex to the proposal, and provide a summary
of key linkages with the national Monitoring and Evaluation Plan and data collection methods.
Embodied in the National M&E plan is the designation of Philippine National AIDS Council (PNAC)
secretariat as the repository of data for the national response. The National Epidemiology Center (NEC)
will be the repository of all health sector data for HIV/AIDS based on Republic Act 8504. All data will be
entered into the Country Response Information System (CRIS). Based on the Department Order no. 2058
series of 2004, the National Epidemiology Center is designated as the M&E Unit for the GFATM. In
69
compliance to this order, the National Epidemiology Center will be collecting data from the field through
the social hygiene clinics, sub-national surveillance unit as well as from the national reference
laboratories and the national HIV/AIDS program and the Philippine Blood Center through its Integrated
Blood Bank Information System (IBBIS) for collation and analysis and submission to the PNAC
secretariat. Merging of data by NEC and PNAC secretariat will be done annually for further analysis and
report dissemination. (Annex 22 National M & E Strategy – DRAFT)
70
4.10 Procurement and supply management of health products
In this section, applicants should describe the management structure and systems currently in place for the
procurement and supply management (PSM) of drugs and health products in the country. When completing this
section, applicants should refer to the Guidelines for Proposals, section 4.10.
4.10.1 Organizational structure for procurement and supply management
Briefly describe the organizational structure of the unit currently responsible for procurement and
supply management of drugs and health products. Further indicate how it coordinates its activities
with other entities such as National Drug Regulatory Authority (or quality assurance department),
Ministry of Finance, Ministry of Health, distributors, etc.
In response to Republic Act 9184 also known as the Government Procurement Reform Act, the
Department of Health Procurement and Logistics Service re-organized its structure separating
procurement with materials management divisions to provide check and balance to the system.
Procurement Division, by virtue of Administrative Order No.131 s. 2002 was also designated as the
organic office to act as the Secretariat to the Central Office Bids and Awards Committee (COBAC)
pursuant to Section 11 of Executive Order No. 40. Further, to keep pace with the directions set out by RA
9184, the office was further divided into two main units: (1) Planning and Management Support Unit (2)
Procurement Operations Unit. The former is in-charge with the procurement planning, price data analysis,
suppliers’ registry, standards development and research pertaining to procurement management. The
latter takes on with the actual conduct of procurement activities for goods and other related services, civil
works and consulting services pursuant to existing laws and guidelines prescribed by the international
funding institutions.
Procurement of equipment, commodities, and health products such drugs and medicines are carried out
through the COBAC, which is a transparent Committee handling requests for procurement using strict
guidelines stated under the new law. Procurement of medicines and supplies through international
procurement systems such as Global Drug Facility, UNICEF and WHO funded by the government or
foreign assisted projects does not pass through the COBAC. All health products are required to have
Certificate of Product Registration (CPR) from Bureau Food and Drugs (BFAD) of the Department of
Health. COBAC has instructed the BFAD to prioritize processing and approval of applications related to
procurement to ensure timely provision of drugs and medicines intended for national programs (i.e EPI
Vaccines, TB Drugs, Rabies Vaccines, STH Drugs and Vitamin A). HIV and AIDS antiretroviral drugs and
HIV test kits were among health products given exemption by BFAD through a Department Order. DOH
procured PhP10 million worth of second line ARVs and diagnostics and monitoring kits from UNICEF in
2005. (Annex 20 Policy and Requirements for Availing ARV and Test Kits)
For consulting services, the process was strengthened by linking with the umbrella organization to
provide a wider pool of invitees for consultancy services. The division also started building up the
database of consultants both for individual and firms. Various automation and web-based application
procedures are envisaged. Among which is the further enhancement of the Logistics Management
Information System (LMIS), price monitoring system, online registration for SSRS, database of suppliers
and consultants, integration of existing pockets of systems from Procurement Division, Materials
Management Division and Finance Service into an inter-operational system, in the and web-based
feedback mechanism down to the CHDs and retained hospitals.
To further promote true transparency in the procurement process and strengthen linkage with the civil
society organizations, the Department of Health has entered and signed a Letter or Partnership /
Involvement with the Transparency and Accountability Network on 26 August 2005. The former has also
developed a “Deployment Matching Software” to efficiently mobilize their CSO observers given the
captioned procurement package and agency’s preference. Included among the provisions of the Letter of
Partnership is the testing of the functionality of the said system in the Department.
71
4.10.2 Procurement capacity
a) Will procurement and supply management of drugs and health
products be carried out (or managed under a sub-contract) exclusively
by the Principal Recipient or will sub-recipients also conduct
procurement and supply management of these products?
Principal
Recipient only
Sub-recipients
only
Both
b) For each organization involved in procurement, please provide the latest available annual data
(in Euro/US$) of procurement of drugs and related medical supplies by that agency.
For the HIV Program of the DOH, the latest available data is its procurement of P10 million worth of anti
retroviral drugs, reagents and supplies through the UNICEF. The process was carried out from
submission of specifications, quotation by UNICEF until the actual delivery to the DOH warehouses within
the allowable time frame for procurement of goods under the RA 9184. The unforeseen delay was
caused during the actual delivery to the end user and the product testing for quality assurance by the
BFAD. The procurement was started in December 2005 and the deliveries of ARV, reagents and
commodities started to arrive in January to May 2006.
Other DOH Central Office procurement activities from since 2004 are listed below:
List of Major Health Products Procured By DOH Central Office from 2004 to 2006*
Amount By Type of Funding
Year
2004
ITEM
Gaschromatograhp Mass
Spectrometer (GCMS)
system
15,000,000.00
15,000,000.00
Portable Pulse Oximeter
1,098,000.00
1,098,000.00
Various Pharmaceuticals
12,552,567.16
12,552,567.16
4,786,441.00
4,786,441.00
Various Pharmaceuticals Re-bid
Supply and Delivery of TB
Drugs for Children
Supply and Delivery of TB
Laboratory supplies
Supply and Delivery of
various Medical
Instruments
Supply, Delivery &
Installation of X-Ray eqpt.
In AMMA, JADSAC Dist.
Hosp.
Suply, Delivery &
Instaqllation of various
hosp. Equipt. To various
Health Facililties
Supply & Delivery of
Domestic Refrigerators
Supply, Delivery &
Installation of various
Laboratory for Kalinga
Provincial Hosp.
Gaschromatography Mass
Spectrometer (GCMS)
system (QUADRUPOLE)
ABC (PhP)
DOH
International
FUNDING
SOURCE
NRL
/EAMC
SUPPLIERS
Molave Trading
7,128,000.00
7,128,000.00
13,781,500.00
13,781,500.00
SARS
OSEC,
HEMS,
DTTB, &
IDO
OSEC,
HEMS,
DTTB, &
IDODDO
SEMP2/I
DO
SEMP/ID
O
555,800.00
ICHSP
V.G. Roxas Co.,
Inc
1,500,000.00
1,500,000.00
ICHSP
NPK Medical
Trading
5,000,000.00
5,000,000.00
ICHSP
Philippine Medical
Dental
476,000.00
ECD
Blue Sky Trading
5,500,000.00
ICHSP
Dakila Trading
NRL
/EAMC
Molave Trading
555,800.00
476,000.00
5,500,000.00
7,000,000.00
7,000,000.00
Maystar Company
Medgen
Laboratories
Blue Sky Trading
Natrapharm Inc
Rebmann Inc
72
Gaschromatography Mass
Spectrometer system
(IONTRAP)
2005
2006
8,000,000.00
8,000,000.00
NRL
/EAMC
NCDPC
Procurement of TB
laboratory Supplies
5,363,008.00
5,363,008.00
17,442,200.00
17,442,200.00
3,743,618.00
3,743,618.00
Personal Protective
Procurment of laboratory
Equipment
Procurement of ORS &
chlorine Granules
Procurment of Oral
Rehydration Salts &
Chlorine Granules
999,000.00
999,000.00
563,200.00
Procurement of Various
Pharmaceuticals & Topical
Procurement of TB
Supplies
Procurement of TB Drugs
for Children
TOTAL
Percentage Distribution
(%)
IDO
DTTB,
IDODDO,
HEMS
Molave Trading
Phil Pharmawealth
Inc
Medical Center
Trading/Blue Sky
Technomed
International
563,200.00
HEMS
NRL
/EAMC
Blue Sky Trading
MRL Cybertech
Corp
250,000.00
250,000.00
HEMS
Micel Marketing
250,000.00
250,000.00
Micel Marketing
22,564,940.00
22,564,940.00
HEMS
OSEC,
DTTB,
HEMS,
IDO
On-going
8,743,530.00
8,743,530.00
IDO
On-going
6,100,777.50
6,100,777.50
IDO
On-going
148,398,581.66
114,457,281.66
33,941,300.00
100%
77%
23%
* procurement made through normal bidding process - does not include international procurement through international procurement
4.10.3 Coordination
a) For the organizations involved in section 4.10.2.b, indicate in percentage terms, relative to total
value, the various sources of funding for procurement, such as national programs, multilateral
and bilateral donors, etc
National (DOH) funding constitutes seventy-seven percent (77%) of the procurement of medicines and
health products while international and bilateral funded procurement accounts to the remaining twenty
three percent (23%). The data only accounts for the procurement through the Central Office Bids and
Awards Committee (COBAC) bidding process and does not cover the direct transactions to international
procurement services such as WHO, UNICEF and Global Drug Facilities.
b) Specify participation in any donation programs through which drugs or health products are
currently being supplied (or have been applied for), including the Global Drug Facility for TB
drugs and drug-donation programs of pharmaceutical companies, multilateral agencies and
NGOs, relevant to this proposal.
None
4.10.4 Supply management (storage and distribution)
Yes
a) Has an organization already been nominated to provide the supply
management function for this grant?
Î continue
No
Î go to 4.10.5
b) Indicate, which types of organizations will
be involved in the supply management of
drugs and health products. If more than
National medical stores or equivalent
Sub-contracted national organization (specify
73
one of the boxes below is ticked, describe
the relationships between these entities.
which one(s))
Sub-contracted international organization(s)
(specify which one(s))
Other (specify)
Local Government units will procure some
commodities and equipments, and will be
involved in supply management
c) Describe the organizations’ current storage capacity for drugs and health products and indicate
how the increased requirements will be managed.
The DOH has existing warehouses in Manila (DOH Central Office), Mandaluyong (Population
Commission), Quezon City (Quirino Memorial medical Center) and Muntinlupa (Research Institute for
tropical Medicine) which have storage capacities for both refrigerated, air conditioned and room
temperature supply requirements. The increased influx of reagents, which will need refrigeration will be
addressed by expanding these storage areas of the DOH Central Office warehouse by the management.
Additional support will be provided by the project which will be taken from the management cost..
d) Describe the organizations’ current distribution capacity for drugs and health products and
indicate how the increased coverage will be managed. In addition, provide an indicative
estimate of the percentage of the country and/or population covered in this proposal.
The present system is centralized at the national, sub national DOH offices. Deliveries were coursed
through the sub-national office by a private logistics company. However, the system of monitoring and
feedback mechanism is still being developed.. Needless to say, the PR will rely on the personnel at the
national (both central office and CHDs) office; project site personnel and the local government units staff
for stock inventory reports.
[For tuberculosis and HIVAIDS components only:]
4.10.5 Multi-drug-resistant TB
Does the proposal request funding for the treatment of multi-drug-resistant
TB?
Yes
No
If yes, please note that all procurement of medicines to treat multi-drug-resistant tuberculosis financed by the
Global Fund must be conducted through the Green Light Committee (GLC) of the Stop TB Partnership.
Proposals must therefore indicate whether a successful application to the Committee has already been made
or
is
in
progress.
For
more
information,
please
refer
to
the
GLC
website,
at
http://www.who.int/tb/dots/dotsplus/management/en/. Also see the Guidelines for Proposals, section 4.10.5.
74
4.11 Technical and Management Assistance and Capacity-Building
Technical assistance and capacity-building can be requested for all stages of the program cycle, from the time of
approval onwards, including in respect of , development of M&E or Procurement Plans, enhancing management
or financial skills etc. When completing this section, applicants should refer to the Guidelines for Proposals,
section 4.11.
4.11.1 Capacity building
Describe capacity constraints that will be faced in implementing this proposal and the strategies that
are planned to address these constraints. This description should outline the current gaps as well
as the strategies that will be used to overcome these to further develop national capacity, capacity
of principal recipients and sub-recipients, as well as any target group. Please ensure that these
activities are included in the detailed budget.
Implementation of the round 6 sites poses some challenges for the implementers because of the
following: HIV/AIDS prevention activities are not yet institutionalized in most of the identified sites, local
staff are not familiar with STI etiologic surveillance as well as with the Integrated HIV/AIDS Behavioral
and Serologic Surveillance, reporting system needs strengthening, referral system though in place may
yet to be reviewed, particularly from VCCT to treatment, care and support, skills in public education and
recruitment of voluntary blood donors may need to be harnessed. Round 6 proposal addresses these
gaps by giving out trainings to sub-national as well as the local government unit staff. Trainings will be
provided for peer educators on the delivery of behavior change strategies (education and condom), STI
etiologic diagnosis and reporting, comprehensive STI management, VCT, blood donor recruitment, total
quality management in blood services, rational use of blood among health care workers, PMTCT, clinical
management of HIV/AIDS including ARV, team preparation for the conduct of IHBSS, use of SSESS
software, use of IBBIS and provision of continuing education for PMO staff.
4.11.2 Technical and management assistance
Describe any needs for technical assistance, including assistance to enhance management
capabilities. (Please note that technical and management assistance should be quantified and reflected in the
component budget section, section 5.6)
Strengthening the health system related to HIV/AIDS program entails investment particularly on its
manpower. To be able to lead, the prime movers of the program, i.e., the program managers need the
latest updates on the technical as well as the managerial aspects of STI/HIV/AIDS prevention, treatment
and care. Technical assistance may take the form of hiring international and local consultants, study tour
and in-house training in international training centers like the US CDC. Although the Department of
Health has its institutionalized system for program management, procurement and supply management,
finance, monitoring and evaluation, there is a need to upgrade the Department on the state-of-the-art
management that will carry the whole health system to excellence.
An SR for technical assistance among the international and multilateral/bilateral agencies. The activity
would include provision of required technical assistance such as hiring of local or foreign consultant. It will
also cover for the technical support needed by the PR for the management of the Project such as TA for
procurement, finance, M&E and project management. A lump sum TA package was included in the
budget to cover for unexpected TA during the Project implementation.
75
Expected TA Needs (5 Years)
SDA
Input Description
Quantity
Unit Cost (US $)
Budget Estimate
(US $)
STI diagnosis and
treatment
VCT
Training/Consultant
4
7,000.00
28,000.00
3
18,000
54,000
3
5,000
15,000
(2 pax/year for 2 years)
Training/Consultant
(1pax/year for 3 years)
PMTCT
Fellowship training
(1 pax/year for 3 years)
Information System and
Surveillance
Consultant for Surveillance
in year 1 and 5 (For every
year: 3X: during team
preparation, analysis,
technical review)
2
51,720.00
103,440.00
Provision of ARV and OI
Fellowship/In house training
(year 3)
10
5,500.00
55,000.00
Unprogrammed TA
TA needs arising during the
implementation of the
Project
5
4,000.00
20,000.00
76
5 Component Budget HIV/AIDS
PLEASE NOTE THAT THIS SECTION IS TO BE COMPLETED FOR EACH COMPONENT.
In this section, applicants will need to provide summary budget information for the proposed duration of the component.
Applicants are also required to provide a more detailed budget as an annex to the proposal. For more information on
budget requirements, please refer to the Guidelines for Proposals, section 5.
If part or all of the funding requested for this component is to be contributed through a
common funding mechanism (consistent with section 4.6.7), applicants should provide:
•
Compile the Budget information in sections 5.1 – 5.6 on the basis of the anticipated use, attribution
or allocation of the requested funds within the common funding mechanism; and
•
Provide, as an annex, the available annual operational plans/projections for the common funding
mechanism and explain the link between that plan and this funding request.
77
5.2 Detailed Component Budget
The Component Budget Summary (section 5.1) must be accompanied by a more
detailed budget covering the proposal period, attached as an annex to the proposal.
The detailed budget should also be integrated with the Work Plan referred to in section 4.6.
The Detailed Component Budget should meet the following criteria (Please refer to the Guidelines
for Proposals, section 5.2):
a) It should be structured along the same lines as the Component Strategy—i.e., reflect the same
goals, objectives, service delivery areas and activities.
b) It should cover the term of the proposal period and should:
i) be detailed for year 1 and year 2 of the proposal term, with information broken down by
quarters for the first year;
ii) provide summarized information and assumptions for the balance of the proposal period
(year 3 through to conclusion of proposal term).
c) It should state all key assumptions, including those relating to units and unit costs, and should be
consistent with the assumptions and explanations included in section 5.3.
d) It should be integrated with the detailed Work Plan for year 1 and indicative Work Plan for year 2
(please refer to section 4.6).
e) It should be consistent with other budget analyses provided elsewhere in the proposal, including
those in this section 5.
79
5.3 Key budget assumptions
Without limiting the information required under section 5.2, please indicate budget assumptions for year 1 and
year 2 in relation to the following:
5.3.1 Drugs, commodities and products
Please use Attachment B (Preliminary Procurement List of Drugs and Health Products) in order to compile the
budget request for years 1 and 2 in respect of drugs, commodities and health products. Please note that unit
costs and volumes must be fully consistent with the information reflected in the detailed budget. If prices from
sources other than those specified below are used, a rationale must be included.
a) Provide a list of anti-retroviral (ARVs), anti-tuberculosis and anti-malarial drugs to be used in the
proposed program, together with average cost per person per year or average cost per
treatment course. (Please complete table B.1 in Attachment B to the Proposal Form.)
b) Provide the total cost of drugs by therapeutic category for all other drugs to be used in the
program. It is not necessary to itemize each product in the category. (Please complete table B.2 in
Attachment B to the Proposal Form.)
c) Provide a list of commodities and products by main categories e.g., bed nets, condoms,
diagnostics, hospital and medical supplies, medical equipment. Include total costs, where
appropriate unit costs. (Please complete table B.3 in Attachment B to the Proposal Form.)
(For example: Sources and Prices of Selected Drugs and Diagnostics for People Living with HIV/AIDS.
Copenhagen/Geneva,
UNAIDS/UNICEF/WHO-HTP/MSF,
June
2003,
(http://www.who.int/medicines/organization/par/ipc/sources-prices.pdf); Market News Service, Pharmaceutical
Starting Materials and Essential Drugs, WTO/UNCTAD/International Trade Centre and WHO
(http://www.intracen.org/mns/pharma.html); International Drug Price Indicator Guide on Finished Products of
Essential Drugs, Management Sciences for Health in Collaboration with WHO (published annually)
(http://www.msh.org); First-line tuberculosis drugs, formulations and prices currently supplied/to be supplied by
Global Drug Facility (http://www.stoptb.org/GDF/drugsupply/drugs.available.html).)
ARV prices were based on the last year’s quotation by UNICEF. STI and other OI drugs were based
on the local market price.
5.3.2 Human resources costs
In cases where human resources represent an important share of the budget, explain how these
amounts have been budgeted in respect of the first two years, to what extent human resources
spending will strengthen health systems’ capacity at the patient/target population level, and how
these salaries will be sustained after the proposal period is over. (Maximum of half a page. Please
attach an annex and indicate the appropriate annex number.)
The total budget for HR is US$1,616,295 (8.816% of the total grant). This will go to the peer educators
based at the 16 SHC, the staff who will man the migrant workers’ desk at each LGU, staff in charge of the
outreach posts for MSM and clients of sex workers and part-time MDs in ten sites, five drivers for the
national and three sub-national blood centers, consultant who will work on ARV market segmentation
approach, 12 site implementation officers based at the sub-national DOH offices and 12 PMO staff.
Salary was computed based on the man hour and expertise that will be given to the assigned task. (See
detailed budget: Annex B).
It must be noted that the Philippines is experiencing a rapid turn over of its health work force, especially
doctors, nurses and laboratory personnel because of economic reasons. The additional staff, particularly
at the SHC of each local government unit will strengthen the facility’s services. Peer educators will be
assisting the SHC physician by conducting BCC activities and assist even in VCT. This will help the
physician focus on other technical work such as patient diagnosis and treatment while BCC and VCT
services are being promoted. The scheme of linking the SHC with other private facilities and hospitals is a
good strategy to create a less stigmatized image for the SHC and entice more clients to avail of its
services. Likewise, provision of an additional pay of $20/month to the migrant workers’ desk staff will
create demands for HIV/AIDS prevention services like VCT which eventually will be beneficial to the LGU
and the staff.
80
During the project life, it is designed that mechanisms will be worked out for the LGU to absorb the staff
hired by Global Fund and provide incentives for additional work done through a memorandum of
understanding. In 2005, the Department of Budget and Management (DBM) issued a circular that a
certain percentage of the Internal Revenue Allotment (IRA) will go to HIV/AIDS prevention and control
services.
It is important that an incentive system for Project staff and for the government staff working for the
operational and technical aspects of the Project. The management cost of the PR will provide for the
augmentation support and subsistence/honorarium for government workers through a system of rewards
and incentive (guidelines to be set by the DOH). The cost of which should not be more than 40% of the
basic pay, which is within the ceiling of allowable honorarium.
5.3.3 Other key expenditure items
Explain how other expenditure categories (e.g., infrastructure, equipment), which form an important
share of the budget, have been budgeted for the first two years. (Maximum of half a page. Please attach
an annex and indicate the appropriate annex number.)
For years 1 and 2, commodities and products comprise a major share of the budget, i.e., 32% and
49%, respectively. Most of the CP to be procured are HIV testing kits to be used in SHC and treatment
centers. Less than two million dollars will be spent in years 1 and 2 for Transfusion Transmissible
Infections (HIV, syphilis, hepatitis B and C and malaria) reagents. This was computed at 50,000 blood
units to fill in the gap resulting from the closure of commercial blood banks (currently providing 75,000
units). Another major share from CP expense will be the tri-media which involves contracting out a
marketing and advertising firm to design the advocacy campaign on healthy lifestyle and HIV
prevention and to promote via television, radio and prints.
Infrastructure and equipments comprise 25% of the total year 1 budget. This will cover rental of an
MSM outpost clinic in ten identified sites, computers for the 16 SHC , PMO, and partner public health
facilities, equipments (speculum, centrifuge, microscope) for the SHC, five motorcycles (for national
and 3 sub-national blood centers), setting up of two new treatment hubs and reproduction and
distribution of learning materials for primary and secondary students.
STI drugs were computed based on the STI prevalence in the 11 Global Fund sites of round 3 and the
regular SSESS sites (GC 11% male, 0.88% female; NGI 7% male, 12% female; syphilis: 0.11%;
genital herpes: 0.02%; genital wart: 0.155%; trichomoniasis: 5%; bacterial vaginosis: 2%).
Around $200,000 will be spent for the operationalization of IBBIS. This will cover the cost for server
hosting in years 1 to 3. Since there will be a mechanism for the return of investment (through
subscription by private, government and NGO BSF), budget for years 4 and 5 were no longer
requested as the system is designed for sustained operations.
81
5.4 Breakdown by service delivery area
Please provide an approximate allocation of the annual budget for each service delivery area (SDA). The objectives and service delivery areas listed should resemble those in
the Targets and Indicators Table (Attachment A to the Proposal Form). It is anticipated that this allocation of the budget across SDAs should be derived from the detailed
component budget (see section 5.2).
Table 5.4: Estimated budget allocation by service delivery area and objective.
Budget allocation per SDA (in Euro/US$)
Objectives
Service delivery area
#1: Increased access of MARPS
and general population to VCT
Prevention: BCC - community outreach
#1
Year 1
Year 2
Year 3
Year 4
Year 5
94,528
68,160
68,160
68,160
68,160
Prevention: STI diagnosis and treatment
181,784
167,784
181,784
167,784
181,784
#1
Prevention: Testing and Counseling
256,710
155,710
72,460
72,460
42,460
#1
Prevention: PMTCT
21,690
29,690
42,460
1,690
1,690
#1
Information system & Operational research
664,540
315,265
255,265
39,921
270,206
#2: Ensure safe blood supply
Prevention: BCC - Mass media
134,400
106,400
106,400
106,400
106,400
#2
559,350
59,350
59,350
40,000
40,000
#2
Prevention: Blood safety and universal precaution
1,225,119
975,467
1,835,467
1,856,200
1,816,200
#3: Scale up treatment, care and
support
Treatment: Antiretroviral treatment (ARV) and
monitoring
143,400
128,400
1,243,600
243,600
243,600
82,800
85,800
85,800
85,800
87,800
48,000
38,000
48,000
50,000
50,000
12,800
12,800
12,800
12,800
12,800
47,200
47,200
47,200
47,200
47,200
#3
#3
#3
#4: Health systems
strengthening
Treatment: Prophylaxis and treatment for
opportunistic infections
Care and support: Care and support for the
chronically ill
Supportive environment: Stigma reduction in all
settings
Supportive environment: Coordination and
partnership development (national, community,
public-private)
82
Objectives
Supportive environment: Strengthening of civil
Year 1
Year 2
Year 3
Year 4
Year 5
611,724
400,004
371,004
293,004
344,724
NET Total: (No management cost yet)
4,084,045
2,590,030
3,386,980
3,085,019
3,313,024
Total (w/ Management Cost)
4,574,130
2,900,834
3,793,418
3,455,221
3,710,587
#4
83
5.5 Breakdown by implementing entities
Indicate in table 5.5 below how the resources requested in table 5.1 will, in percentage terms, be allocated among
the following categories of implementing entities.
Table 5.5 – Allocations by implementing entities
Fund allocation to implementing partners (in percentages)
Year 1
Academic/educational sector
Year 2
Year 3
-------
2.32%
-------
68.29%
75.44%
Nongovernmental / communitybased org.
4.83%
Organizations representing
people living with HIV/AIDS,
tuberculosis and/or malaria
Year 4
Year 5
-------
-------
81.37%
89.27%
88.02%
4.72%
3.61%
4.20%
3.91%
--------
--------
--------
-------
-------
26.80%
17.40%
14.93%
6.43%
7.97%
Religious/faith-based
organizations
0.08%
0.12%
0.09%
0.10%
0.10%
Multi-/bilateral development
partners
---------
---------
--------
-------
-------
100.00%
100.00%
100.00%
100.00%
100.00%
Government
Private sector
Others.
Please specify:
Total
5.6 Budgeted funding for specific functional areas
The Global Fund is interested in knowing the funding being requested for the following three important functional
areas—monitoring and evaluation; procurement and supply management; and technical and management
assistance. Applicants are required in this section to separately identify the costs relating to these functional
areas. In each case, these costs should already be included in table 5.1. Therefore, the tables below should be
subsets of the budget in table 5.1., rather than being additional to it. For example, the costs for monitoring and
evaluation may be included within some of the line items in table 5.1 above (e.g., human resources, infrastructure
and equipment, training, etc.).
Table 5.6 – Budgets for specific functional areas
Funds requested from the Global Fund (US$)
Year 1
Year 2
Year 3
Year 4
Year 5
Total
Monitoring and
Evaluation
527,986
124,232
79,432
124,232
327,517
1,183,398
Procurement
and Supply
Management
304,806
304,806
304,806
63,620
63,620
952,058
84
Year 1
Technical and
Management
Assistance
265,126
Year 2
191,520
Year 3
91,840
Year 4
4,480
Year 5
62,406
Total
615,058
Monitoring and Evaluation: This includes: data collection, analysis, travel, field supervision visits, systems and
software, consultant and human resources costs and any other costs associated with monitoring and evaluation.
Procurement and Supply Management: This includes: consultant and human resources costs (including any
technical assistance required for the development of the Procurement and Supply Management Plan), warehouse and
office facilities, transportation and other logistics requirements, legal expertise, costs for quality assurance (including
laboratory testing of samples), and any other costs associated with acquiring sufficient health products of assured
quality, procured at the lowest price and in accordance with national laws and international agreements to the end user in
a reliable and timely fashion. Do not include drug costs, as these costs should be included in section 5.3.1.
Technical and Management Assistance: This includes: costs of consultant and other human resources that
provide technical and management assistance on any part of the proposal—from the development of initial plans,
through the course of implementation. This should include technical assistance costs related to planning, technical
aspects of implementation, management, monitoring and evaluation and procurement and supply management.
85
"Philippines CCM Round 6 Proposal HIV/AIDS Component - Clarifications Regarding
Sections 4, 5 and Annexes"
Please find the following response and clarification regarding Philippines HIV/AIDS Round 6
Proposal:
1.
Section 4.5 - Financial and pragmatic gap analysis
We invite you to revise table 4.5.1-3 as it is not make any reference in the external
sources to The Global Fund grants which you are all ready the recipient. Could we
also kindly request that you provide more detail in this table by separating all the
donors listed under External Source 2 and detail all the organisations contribution.
We are re-submitting Table 4.5.1-3, with more detailed external sources of
financing. (Annex A – Table 4.5. 1-3 revised).
Table 4.5.1-3 used the National AIDS Spending Assessment (NASA) by the
National Economic Development Authority (NEDA) and Philippine National
AIDS Council (Annex A.1 - NASA) for calendar year 2000 to 2004. Data for
2005 to 2010 is not yet available. Our original response to Table 4.5.1-3
(External Source 2) includes an assumption that there will be same level of
funding support from the listed donor agencies from 2004 to 2010.
Moreover, national investment plan for HIV/AIDS is being developed at the
country level including costing the needed resources to operationalize the
Fourth AIDS Medium Term Plan. As of this writing, UNICEF was able to give
their budget allocation for 2005 to 2009, UNFPA and WHO gave their partial
budget allocation for HIV/AIDS.
2.
Section 4.6 – Component strategy
a)
We would like to thank you for sending us a completed Targets and Indicators table.
However, could we recommend that you provide us with a detailed justification
regarding the indicators for which there is no baseline or a zero figure. As you are
aware The Global Fund is a performance base funder and the TRP will pay particular
attention to this element of the proposal. Could we also kindly ask you to provide us
with numbers both numerators and denominators for the SDA targets for which you
have given us percentages.
We are re-submitting the Attachment A – Indicators Table, with the completed
baselines. We have noted as well in the same attachment comments including
numerators and denominators in each baseline with percentages based on what
is available as of this time.
1
b)
We would like to thank you for sending us a completed Targets and Indicators table.
However, we have noted that the SDA you have listed do not correspond with those
entered in section 4.6.1. Could we kindly ask you to resubmit both documents, as
well as any other where the number of SDA’s are referred to, as this needs to be
consistent throughout the proposal (for example in Section 4.6.3: Activities)
We apologize for the inconsistencies between the two sections (4.6.1 and
4.6.3). We are re-submitting the whole 4.6 section labelled as ‘Attachment 4.6
Section’ to this email. We have noted that indeed there are some
inconsistencies in the numbering of objectives under 4.6.1 with that of the other
sections or attachment of the proposal. The section 4.6.1 has been corrected
accordingly.
c)
We kindly ask you to reconsider the amounts that you have entered in table 4.6.4
as there seems to be some discrepancies between this information and the
disbursement data that we have here at The Global Fund.
As of July 31, 2006, the disbursed amount for the on-going implementation of
the Round 3 HIV/AIDS Project Phase 1 is US$ 3,053,529. This is part of the
total Phase 1 and 2 budget of US$ 3,496,865 and US$ 2,031,960 respectively
and is equivalent to the Total Grant Amount of US$ 5,528,825. (Please see
Attached 4.6 Section)
d)
Could we kindly request that you resubmit table 4.6.9 as the SDA do not always
correspond to those mentioned in other documents. With regards to the information
to be provided please be aware you must include the estimated number of people
reached as well as the percentage.
Please refer to the resubmitted 4.6 section for the number of people reached in
the Table 4.6.9. (Please see Attachment 4.6 Section)
3.
Section 4.8 – Program and financial management
a)
Could we please invite you to provide more detailed information in section 4.8.3f
regarding the reasons why sub-recipients were not selected prior to submission of
the proposal.
2
On Section 4.8.3f, as to why sub-recipients were not selected prior to
submission of the proposal:
1. During the meeting for the endorsement of the Round 6 proposals, sub
recipient for the Technical Assistance component of the HIV/AIDS
proposal was presented but was not adequately discussed. The TA subrecipient will undergo the approved process for selection of PR/SR by
the Proposal Screening Committee and the CCM.
2. The HIV/AIDS proposal is designed to strengthen the health systems to
complement the increased demand for HIV/STI related services in
priority HIV/AIDS prevention, treatment and care sites. Hence, the
Programs under and inherent to the Department of Health will be
implementers/sub-recipients. The following Programs will be directly
involved:
2.1.
National AIDS STD Prevention and Control Program – to
implement the health systems development for STI and
HIV/AIDS prevention, VCT, treatment and care services.
2.2.
Philippine Blood Center under the auspices of the National
Voluntary Blood Services Program – to implement the blood
safety components of the Proposal
2.3.
National Epidemiology Center – implement the surveillance,
information generation, analysis and dissemination including
monitoring
b)
Could we please ask you to invite country to provide more detailed information in
section 4.8.3.g regarding the process that will be used to select sub-recipients if the
proposal is approved, including the criteria that will be applied in the selection
process.
The abovementioned implementers were pre-selected as SR/implementors
based on mandates of each Program:
1. National AIDS STD Prevention and Control Program (DOH) – is the
national Program for HIV and STI in the country and is the main
technical agency of the DOH for HIV/AIDS. See Annex B – AO 119 s.
1992 NASPCP Mandate;
2. Philippine National Blood Center (PNBC or PBC) – is the main
implementing arm of the National Voluntary Blood Services Program
for the country’s blood program. (Annex C – Administrative Order
NVBSP 2005-00020)
3. National Epidemiology Center – is the health program monitoring and
evaluation Office of the Department of Health. It has also been
designated as the AIDS Watch of the Philippines for collection,
3
analysis and dissemination of the HIV/AIDS data and the monitoring
unit for GFATM Projects for tuberculosis, malaria and HIV/AIDS.
(Annex D - DPO 2058 s. 2004).
The SR for Technical Assistance will be decided by the CCM in a transparent
manner. The process implemented in the previous rounds for selection of PR
and SR shall be used in the selection of SR for TA. Selection will be done
through open nominations. There will be call for possible SR’s by the CCM
based on approved guidelines (to be developed). Interested parties will apply to
the CCM as SR or can be directly nominated by the PR. The CCM will decide
based on the recommendation of an Ad Hoc Committee, who will assess the
qualifications and previous experience of interested applicants.
The following will be considered during the setting of the criteria:
•
•
•
•
4.
Track record
Experience in GF or large project (FAP)
Financial management systems
Network
Section 4.10 – Procurement and supply management of health products
Could we kindly ask you to provide us with more detail in sections 4.10.3 as to why
this section is N/A.
We are submitting a response to Section 4.10.3 as our initial understanding of it
was whether we have an existing institutionalized Donation Program on drugs,
medicines and other health products for HIV and AIDS control program within
the Department of Health, of which we answered none. Please re-consider the
following response regarding the participation of DOH in some of the donation
activities including those from Global Fund.
1. The DOH is a recipient of health products from various organizations
both local and international agencies in support of our major health
programs such as EPI vaccines, anti-TB drugs, malarial drugs, and
others.
2. The DOH is the regulating agency that provides quality assurance of
internationally procured and donated health products through the Bureau
of Food and Drugs (BFAD). BFAD is the regulatory arm of the DOH in
the registration, monitoring and quality assurance of biological and
pharmaceutical products within the Philippines. (Annex E –
Administrative Order 142, s 2004).
3. For some programs, freight cost and handling is paid for by the DOH,
eg. Anti TB drugs delivered to the Center for Health Development
(regional offices of DOH) from GDF.
4
4. Monitoring distribution of these health products is carried through
specific offices within the DOH, i.e. Materials Management Division and
CHD counterparts.
More specifically for HIV/AIDS, in the current implementation of the round 3
GFATM for HIV/AIDS, DOH took part in the quality assurance of the reagents,
medicines and other health products through the Bureau of Food and Drug
(BFAD). After passing the standards set by BFAD, said commodities were
endorsed to the NASPCP for storage and allocation to the regional and local
health facilities.
5.
Section 5.1 – Component Budget details
a)
We would like to thank you for submitting a detailed work plan. However, as per our
earlier point there seems to be a discrepancy in the structure of the document in
relation to other attachments provided. Could we please ask you to resubmit the
work plan accordingly and with a more detail regarding the duration of the activities
that will be undertaken.
Thank you for pointing to us the discrepancy. Please see revised section 5.1
(Annex F – Table 5.1 revised) on the corrected computation for the
Component Budget Summary. We are also submitting a revised work plan as
attachment to this email, which includes a cover page for the goals, objectives
and SDA, a general work plan with duration (timeframe) of activities under each
SDA, a detailed year 1 and a detailed year 2 work plans with budget.
(Attachment B Detailed Work Plan - revised)
b) We have noted that there is a discrepancy between tables 5.1 (component budget
summary) and 1.2 (Proposal funding summary per component). We kindly ask for
some clarification as to which of the total component amounts and yearly amounts
are correct. Could we also ask you to provide more indication as to the units costs of
many of the activities within the SDA’s mentioned.
We are very sorry for the inaccuracy in the previous computations for table 5.1
(Component Budget Summary) and table 1.2 (Proposal Funding Summary per
Component). The total fund requested from the Global Fund after checking is
US$ 18,434,190 (Annex G – Table 1.2 revised). Please see also revised table
5.1. (Annex F – Table 5.1 revised) Please refer to the revised detailed year 1
and year 2 and general work plan for the unit cost of the activities within the
SDAs. (Attachment B Detailed Work Plan – revised)
5
6.
Breakdown by service delivery area
We have noted that the totals do not correspond with the information provided in
tables 1.2 and 5.1. Could you please clarify as to which of the amounts are correct.
We have reconciled the amount in tables 1.2, 5.1 and 5.4. We are very sorry
for the discrepancy during our initial submission. Please see the revised
Tables as:
•
•
•
•
7.
Table 1.2
Table 2.1.2
Table 5.1
Table 5.4
–
-
Annex G – Table 1.2 revised
Annex I - Counterpart Financing revised
Annex F – Table 5.1 revised
Annex H – Table 5.4 revised
Section 5.6 – Budget funding for specific functional areas
We note that the percentage of funds allocated to Monitoring and Evaluation
represents 6% of the budget. Could we kindly request that you provide some
explanation as to why you have allocated an amount on this activity which is below
the suggested level.
The budget requested for monitoring and evaluation will augment the existing
national programs of the Department of Health. The DOH has an existing
system of reporting at the different levels of program implementation. At the
local level, DOH salaried personnel under the Center for Health Development
will provide the monitoring visits. Impact evaluation will be done by the
National Epidemiology Center which will be funded by this proposal. In
addition to the monitoring activities by the national programs to local
implementation sites, the M & E also covers for the hiring of site
implementation/coordination officers to assist the existing health personnel in
preparation and submission of reports. The budget requested is within the
lower bracket prescribed for M&E.
6
LIST OF ATTACHMENTS & ANNEXES TO THE PROPOSAL - EAP CLARIFICATION:
Annexes /
Attachments
Attachment A
Attachment B
Attachment C
Attachment D
Title
Indicators Table – revised
Detailed Work Plan – revised
Complete Section 4.6 – revised
Philippine HIV/AIDS Component Proposal - updated
Annex A
Annex A.1
Annex B
Annex C
Annex D
Annex E
Annex F
Annex G
Annex H
Annex I
Table 4.5. 1-3 Financial Contribution revised
National AIDS Spending Assessment 2000-2010
Department Order – NASPCP
Administrative Order 2005 -002
Administrative Order 142, s 2004
Administrative Order BFAD
Table 5.1 Detailed Workplan revised
Table 1.2 Total Requested to GF revised
Table 5.4 Breakdown by SDA revised
Table 2.1.2 Counterpart Financing Revised
7
Annex A Table 4.5. 1-3
Please summarize the information from 4.5.1, 4.5.2 and 4.5.3 in the table below.
Table 4.5.1-3 - Financial contributions to national response
Financial gap analysis ( please specify currency: US$)
Actual
2004
Overall needs costing (A)
Planned
2005
18,000,000
2006
23,400,000
Estimated
2007
30,420,000
2008
39,546,000
2009
51,409,800
2010
66,832,740
86,882,562
Current and planned sources of funding:
Domestic source: Loans
Domestic Source¹ National/Local
Programs (est) incl PNAC
Total domestic sources of
funding (B)
3,893,782
3,893,782
3,893,782
3,893,782
654,000 (Loan-KfW)
654,000 (Loan-KfW)
654,000 (Loan-KfW)
654,000 (Loan-KfW)
2,000,000 (Loan – KfW)
2,000,000 (Loan – KfW)
2,000,000 (Loan – KfW)
2,000,000 (Loan – KfW)
2,000,000 (Loan – KfW)
2,000,000 (Loan – KfW)
1,239,782 (Loan –
Netherlands)
1,239,782 (Loan – Netherlands
594,000
1,772,200
1,825,366
1,880,127
1,936,530
1,994,627
594,000
3,248,000
5,665,982
5,719,148
5,773,909
5,830,312
5,888,409
5,955,900
3,466,142
513,494
507,735
641,396
634,412
696,752
30,000
47,282
47,282
Round 3 & Round 5
3,496,865
UN Agencies
UNAIDS (2004)
150,846
UNICEF (2004-2009)
682,492
27,000
UNFPA (CPC6 2005)
Other External Funding
3,893,782
654,000 (Loan-KfW)
594,000
Global Fund Grants
WHO (2004-2007)
2,654,000
654,000 (Loan-KfW)
3,166,252
UNFPA (2005)
96,577
USAID
126,808
JICA
5,500
Packard
23, 461
DFOD
14,538
Ford Fdn
38,269
Plan Int.
5,769
KfW
950,808
ADB
UK
19,192
681,083
600,000
Total external
sources of funding (C)
5,614,664
4,390,829
7,110,917
688,678
4,100,554
696,752
0
Total resources available (B+C)
6,208,664
7,638,829
12,776,899
6,407,826
9,874,463
6,527,064
5,888,409
15,761,171
17,643,101
33,138,174
41,535,337
60,305,676
80,994,153
Unmet need (A) - (B + C)
11,791,336
¹ includes budget from national, local (PS & MOOE)
for both HIV/AIDS and Blood Program; estimated at 3% increase per year
42
Annex A.1
Philippine National AIDS Spending Assessment
NATIONAL AIDS SPENDING ASSESSMENT
PHILIPPINES
(2000-2004)
And
2005
TABLE OF CONTENTS
CHAPTER 1 COUNTRY BACKGROUND................................................ 1
POPULATION AND MAJOR DEMOGRAPHIC PARAMETERS ......................................................................... 1
ECONOMIC PERFORMANCE .................................................................................................................... 1
EDUCATION PROFILE ............................................................................................................................ 2
HEALTH AND HEALTH FINANCING ......................................................................................................... 2
HIV/AIDS EPIDEMIOLOGICAL DATA ..................................................................................................... 4
HIV/AIDS INTERVENTIONS IN THE COUNTRY ........................................................................................ 5
CHAPTER 2 OBJECTIVES AND METHODOLOGY ............................... 7
OBJECTIVE ........................................................................................................................................... 7
METHODOLOGY .................................................................................................................................... 7
DATA COLLECTION SYSTEMS ................................................................................................................. 8
LIMITATIONS ........................................................................................................................................ 9
CHAPTER 3 RESULTS .............................................................................10
FINANCING HIV/AIDS ....................................................................................................................... 10
Figure 1. Total HIV/AIDS spending, 2000-2004 (in thousand Pesos).............................................. 11
Figure 2. Total HIV/AIDS spending by source, 2000-2004 (in thousand Pesos) .............................. 11
Figure 3. Distribution of spending by source, 2000-2004 (in %) ..................................................... 12
NATURE OF HIV/AIDS PROGRAM SPENDING ....................................................................................... 13
Figure 4. Distribution of spending by nature, 2000-2004 (in %) ..................................................... 14
CHAPTER 4 PROGRAM AND POLICY IMPLICATIONS......................14
ANNEXES .................................................................................................17
ANNEX A. DETAILED METHODOLOGY .................................................................................................. 17
ANNEX B. TABLES 1 (BY SOURCE) AND 2 (BY FUNCTION), 2000-2004 ................................................... 21
ANNEX C. LIST OF ABBREVIATIONS..................................................................................................... 22
ANNEX D. SELECTED REFERENCES ...................................................................................................... 24
Chapter 1 Country Background
Population and Major Demographic Parameters
The Philippine population as of 2005 is estimated at 85.2 million spread over a
land area of 300,000 square kilometers and is growing annually at 2.05 percent. Males
made up about 50.36 percent of the population in 2000 while females comprise 49.64
percent. The age structure of Philippine population is a typical broad base at the bottom
consisting largely of children and a narrow top made up of a relatively small number of
elderly. Young dependents belonging to age group 0 to 14 years comprised 37.01
percent. The old dependents (65 years and over) accounted for 3.83 percent, while
59.16 percent comprised the economically active population (15 to 64 years).
As of 2003 total fertility rate (TFR) per woman was 3.5. For 2000-2005,
projected female life expectancy at birth was 70 years, while the projected male life
expectancy at birth was 64 years. In terms of human development index (HDI), the
Philippines ranked 84th (or 0.758) in 2003.
Economic Performance
The Philippine economy, despite internal and external challenges and the
continued increase in oil prices, grew at a respectable pace over the period 2001-2004.
The country’s real Gross National Product (GNP) from 2001 to 2004 grew at an annual
average of 5.05 percent and real Gross Domestic Product (GDP) by an annual average
of 4.52 percent. The annual per capita GDP was estimated at US$1,025.95 using 2004
nominal prices and exchange rate.
Average unemployment rate in 2004 was 11.8 percent, despite efforts to
generate jobs in order to absorb the influx of labor entrants. Underemployment, on the
other hand, is a more serious problem at 17.6 percent. The fiscal deficit also remained
as the major macroeconomic problem in the country. It should be noted that as of 2004,
there were around 889,000 Filipinos working overseas.
1
As of 2003, 30.4 percent of the Filipinos (about 24.7% of Filipino families) were
considered income poor. The poor population had annual income that was below the per
capita poverty threshold of PhP12,267 or PhP5,110 monthly per family of five members.
Urban population in the Philippines was pegged at about 48 percent of the total
population in 2000. Studies predict that the Philippines will be more or less 65 percent
urbanized by 2020.
Education Profile
The Philippines has one of the shortest basic education systems in the AsiaPacific Region—ten years only. Moreover, its quality has also been declining rapidly due
to the effects of rapid population growth and inability of available resources to cope with
the demand. Severe budgetary constraints, coupled with the requirements of an
expanding student population, have led to under-investment in basic education.
Public and private elementary school enrolment reached 13 million for school
year (SY) 2003-2004, up by 1.6 percent from the SY 2000-2001 level of 12.8 million.
Participation rate at the primary level stood at 90.05 percent for SY 2002-2003. Cohort
survival rate (CSR) at the elementary level for SY 2002-2003 was pegged at 69.84
percent. On the other hand, completion rate was about 66.85 percent.
The Philippine basic literacy rate, at 93.4 percent, is one of the highest in
Southeast Asia. Female literacy rate (94.3 percent) slightly edges out male literacy rate
(92.6 percent). The 2003 Functional Literacy Education and Mass Media Survey
(FLEMMS) also showed that 48.4 million (84.1 percent) of the country’s 57.6 million
Filipinos aged 10-64 years are functionally literate. The 2003 rate represents a 0.3
percent improvement from 83.8 percent figure posted in 1994.
Health and Health Financing
The Philippine health system has been inadequate in terms of both financing and
service delivery arrangements, partly resulting from the devolution of responsibilities for
2
health care provision to local governments with the passage into law of the Local
Government Code in 1991. Notably, slight improvements were achieved in terms of key
health indicators. It must be emphasized, however, that there remain large differences
across regions and socioeconomic status with regard to program coverage, access to
health care services and health status in general.
Maternal mortality is considered as one of the most important indicators of a
nation’s health. In 1998, maternal mortality rate (MMR) was estimated at 172 per
100,000 live births. However, because of large sampling errors associated with this
estimate, it is not reflective of the real picture on maternal health. Notably, about 60
percent of births were attended by health professionals for the period 1997-2002.
Infant mortality rate (IMR) was 29 per 1,000 live births and under-five mortality
was 40 per 1,000 live births in 2003. About 60 percent of children 12-23 months have
been immunized with vaccines against the six preventable childhood diseases
(tuberculosis, diphtheria, pertussis, tetanus, polio, and measles) before one year of age.
In terms of spending for health, the total health expenditures in the Philippines
(2003 Philippine National Health Accounts, NSCB) reached PhP136.0 billion in 2003,
from Php 117.2 billion in 2002 indicating a 16.0 percent growth at current prices. In real
terms (1985 prices), total health expenditures increased to PhP35.5 billion from PhP32.5
billion, which translates to a 9.4 percent growth.
With the total health expenditure growth at current prices surpassing the
population growth, per capita health spending at current prices registered a PhP200
increase or 13.7 percent from PhP1,462 in 2002 to PhP1,662 in 2003. Health
expenditure per capita at constant prices showed a PhP29 increase or 7.2 percent from
PhP405 in 2002 to PhP434 in 2003.
The share of health expenditure to GNP increased from 2.8 percent in 2002 to
2.9 percent in 2003. However, this improvement is still way below the 5 percent
standard set by the World Health Organization (WHO) for developing countries.
3
In terms of sources of funds for health, the government increased its health
spending from PhP36.3 billion in 2002 to PhP46.5 billion in 2003, demonstrating a 28.2
percent growth. Likewise, social insurance benefit payments grew from PhP10.6 billion
in 2002 to PhP12.9 billion in 2003, translating to a 22.3 percent increase. Although
private sources (out of pocket) registered a mere 8.8 percent growth for 2003, it
continued to be the major source of spending at PhP74.7 billion from PhP68.6 billion in
2002.
With regard to uses of funds for health, spending for ‘personal health care’
constituted 75.7 percent of total spending in 2003. On the other hand, ‘public health’
spending was only 12.3 percent. ‘Other health services’ comprised 12.1 percent.
HIV/AIDS Epidemiological data
The HIV/AIDS situation in the country can be described as hidden and growing.
Based on the HIV/AIDS Registry of the National Epidemiology Center (NEC) of the
Department of Health (DOH), the cumulative number of HIV/Ab seropositive cases since
1984 has reached 2,373 as of October 2005. Epidemiologists and experts, however,
estimate that the actual number of HIV cases is around 10,000. Despite the increasing
number of cases, the prevalence rate remains consistently below one percent.
Of the total HIV/Ab seropositive cases, 1,664 were asymptomatic and 709 were
AIDS cases. Sixty-nine percent of the cases belonged to the 20-39 years age group and
63 percent were males. Of the AIDS cases, 275 already died due to AIDS related
complications. Sexual intercourse (85%) is still the leading mode of transmission. As of
October 2005, there were only 33 reported cases of perinatal transmission. Reported
cases from injecting drug users (IDUs), on the other hand total seven.
Notably, of the 2,373 HIV seropositive cases, 805 (or 34%) of the cases were
overseas Filipino workers (OFWs). These OFWs include seafarers (35%), domestic
helpers (17%), employees (9%), health workers (7%), and entertainers (8%). Seventyfive percent of OFWs were males. The top five common opportunistic infections (OIs)
4
include: tuberculosis (TB), candidiasis, pneumocystis carinii cneumonia (PCP), other
pneumonias/pulmonary infections, and cryptosporidiosis.
The conditions that may engender an AIDS epidemic in the country are present.
Data with regard to the prevalence of sexually-transmitted infection (STI) on registered
female sex workers revealed that gonorrhea is the most common STI with 24 percent
prevalence in sentinel sites based on 2003 data. The top five common STI diagnosis
include: gonorrhea, chlamydia, trichomoniasis, candidiasis, and syphillis.
HIV/AIDS Interventions in the Country
Generally, the policies and programs implemented in the country were in line
with the Republic Act (RA) 8504 or the Philippine AIDS Prevention and Control Act of
1998, and the Third Medium Term Plan (MTP III) on AIDS covering the period 20002004. RA 8504 institutionalized the Philippine National AIDS Council (PNAC) which is
composed of several government agencies and selected NGOs.
Various prevention and control efforts were undertaken both by government
agencies and nongovernment organizations (NGOs). Mass media activities were
implemented by NGOs and LGUs. Condom use promotion was pursued by DKT
Philippines and other USAID funded activities.
Efforts to educate workers on HIV/AIDS were carried out by the Occupational
Health and Safety Center of the Department of Labor and Employment (OHSC-DOLE),
and some NGOs. However, much remains to be done given the large magnitude of the
workforce in the country. To mainstream knowledge on HIV/AIDS, critical information
was incorporated in the curricula of the education system through the School-based
AIDS Education Program (SAEP) of the Department of Education (DepEd). The National
AIDS/STD Prevention and Control Program (NASPCP) of the DOH, on the other hand,
carried out social marketing activities on STI treatment and care, as well as capacitybuilding initiatives.
5
Treatment and care services are being offered by government hospitals, mainly
San Lazaro Hospital (SLH), Research Institute for Tropical Medicine (RITM) and the
Philippine General Hospital (PGH). All these medical centers are located in the capital
city which renders treatment services geographically inaccessible to some persons living
with HIV/AIDS (PLHWAs). NGOs are likewise providing support services, such as the
Positive Action Foundation Philippines, Inc. (PAFPI), among others. Community support
systems were initiated by NGOs and the Department of Social Welfare and Development
(DSWD) to a limited extent. It should be noted that anti-retroviral therapy (ART) is an
out-of-pocket expense unless there are sponsors or donations. In addition, there is no
program yet focusing on care and support for children orphaned by AIDS.
Surveillance activities were continued through the National HIV Sentinel
Surveillance System consisting of both the HIV Serological Surveillance and Behavioral
Sentinel Surveillance under the supervision of the DOH-NEC. Several NGOs and local
government units (LGUs) continued to play a major role in some of the surveillance
activities. Parallel efforts were previously undertaken to develop the capacity of the
STD/AIDS Central Cooperative Laboratory (SACCL) and the RITM in conducting HIV
testing. Presently, HIV testing is being done mainly for employment purposes abroad as
a requirement of other countries. Hence, there really is no “voluntary” counseling and
testing program in place yet.
Advocacy campaigns, training, and research activities were aggressively done by
various NGOs, such as the Health Action Information Network (HAIN), Remedios AIDS
Foundation (RAF), Lunduyan, among others. It should be noted that most of PNAC
member-agency activities were on AIDS program management, advocacy, and training.
In terms of local responses, local AIDS councils (LACs) have been established in
at least 18 sites previously given foreign assistance. These LACs are present in the cities
of: Quezon, Angeles, Baguio, Cebu, Davao, among others. Some of these LACs have
allocated budgets for HIV/AIDS related programs and activities which usually include
IEC, advocacy campaigns, surveillance, and other preventive pursuits.
6
Currently being developed is the national HIV/AIDS monitoring system. The
development and operationalization of this monitoring system aims to institutionalize
monitoring and evaluation of all HIV/AIDS activities and to make reporting easier. Just
recently, the Fourth Medium-Term Plan for AIDS for the period 2005-2010 was
launched. This document contains the strategies that need to be implemented in the
next six years, including the estimated cost requirements.
Chapter 2 Objectives and Methodology
Objective
The objective of this report is to track HIV/AIDS spending over the last five years
(2000-2004) from various sources of financing covering both public and external funds.
The aim of this initiative is to inform policy-makers, program managers, and the donor
community on the magnitude and profile of HIV/AIDS expenditures in the country and
guide them in their planning activities.
Methodology
Primary data collection was undertaken by requesting government agencies,
donor agencies and NGOs to fill up dummy matrices which served as data collection
tools. Two matrices were distributed to track expenditure flows: by financing source and
by financing agents; and by financing agent and by type of activity or function. Donor
agencies were requested to provide information on their total spending on AIDS and all
their agents, and the activities that were undertaken by each of their agents. On the
other hand, NGOs and government agencies were requested to provide all their sources
of financing and their activities by source of financing.
Relevant documents (secondary data) were likewise utilized for some of the
budget data used in this report in the absence of actual expenditure data. These
include: project monitoring documents, National Expenditure Program (NEP) publication
7
of the Department of Budget and Management (DBM), General Appropriations Act
(GAA), and published project accomplishment report.
Some
calculations
using
assumptions
(price-quantity
approach,
using
proportions) with the help of key informant interviews were also made to estimate
relevant expenditure items that are difficult to account (treatment for opportunistic
infections, prophylaxis).
Detailed methodology is in Annex A.
Data collection systems
Information systems for AIDS monitoring and evaluation are apparently not yet
in place. Hence, spending data were collected directly from various sources. Data from
public financing agents (national government agencies, LGUs) were collected through
surveys between September and November. However, not all national government
agencies were able to complete the survey questionnaire (low response rate) given the
difficulty of retrieving historical data (2000-2004). It was for this reason that estimations
were made and secondary data were used, such as the General Appropriations Act or
the National Expenditure Program document, which contains agency budgets.
For local government spending, the Department of Interior and Local
Government (DILG) was requested to collect data from all LGUs. Unfortunately, only
seven LGUs provided the needed AIDS spending data. On the other hand, data from
NGOs were likewise collected using the same survey questionnaire distributed to
government agencies. Again, only a few NGOs were able to comply. NGOs’ spending
data were further validated through the submission of donor agencies’ spending data.
The Project Monitoring Staff of the National Economic and Development
Authority (NEDA) regularly collects data and monitors the progress of foreign-assisted
projects implemented by government agencies (loans and grants covered by Official
Development Assistance). It must be noted, however, that it does not cover
8
expenditures of NGOs and data available are oftentimes not disaggregated according to
the level of detail required for this report (e.g. by health care function).
The tedious data collection process utilized for this report only shows the need
for a strong reporting system that must be put in place in order to ensure a systematic
monitoring and evaluation of all AIDS-related activities. It is therefore crucial that a
strong monitoring and evaluation system be developed which should cover not only
activities, outputs and outcomes, but inputs (amount of investments, financing) as well.
Limitations
It should be noted that not all stakeholders were able to provide the required
data for this report. Expenditures for orphans and vulnerable children were not included
given that there is still no specific national program for children orphaned by AIDS. It
must be noted, however, that regular programs (protective and rehabilitation services)
for orphans and other vulnerable groups are being provided by the DSWD and selected
NGOs.
Only a few NGOs based in Metro Manila directly provided expenditure
information (RAF, HAIN, Lunduyan, and DKT Phils.) on HIV/AIDS. Notably, there are
plenty of NGOs all over the country that are actively involved in HIV/AIDS activities. In
addition, because of time, financial and geographical constraints, only a few LGUs were
able to provide expenditure data for some of the years covered in this report.
The expenditures classified in this report under voluntary counseling and testing
(as reflected in Table 2 matrices in annex) is not really “voluntary”. Most people who go
to clinics or hospitals for HIV testing do so mainly for employment purposes abroad as a
requirement of the receiving country. Hence, it may not actually be considered
“voluntary”.
Moreover, with regard to expenditures of public health facilities, only the budgets
of San Lazaro Hospital and the RITM were calculated because these two hospitals are
considered the major providers of treatment services and given the lack of information
9
on other health facilities that provide these services. It should be noted that cost of antiretroviral therapy (ART) is usually borne by the AIDS patient. Spending of provincial and
local hospitals, including social hygiene clinics for STD management and other
prevention activities are not captured in this report.
Some of the expenditure items were also not broken down into specific functions
or activities and some donors (source of financing) were not able to break down their
expenditures according to their specific agents (subcontractors or implementors). In
addition, spending for universal safety precautions and screening for blood transfusion
were not included in this report given the lack of information and time constraints,
although these activities are being undertaken.
Chapter 3 Results
The results of the survey may be analyzed on several dimensions. It may be
examined on the basis of sources of financing in the last five years (whether domestic or
public sources, or external sources). Another point of analysis is by implementing agent.
Lastly, the results may be evaluated on the basis of the type of activity the resources
were spent on.
Refer to Essential Indicators Table.
Financing HIV/AIDS
Total AIDS spending over the last five years (2000-2004) is estimated at PhP1.4
billion. Spending peaked in 2001 largely because of the huge amounts of resources
provided by donor agencies—United States Agency for International Development
(USAID) and Japan International Cooperation Agency (JICA). During this year, USAID
poured resources leading to the completion of the AIDS Surveillance Education Project.
On the other hand, JICA provided funding assistance for the establishment of the SACCL
at the San Lazaro Hospital. Total expenditures slowly declined in the succeeding years.
10
Figure 1. Total HIV/AIDS spending, 2000-2004 (in thousand Pesos)
500,000
400,000
300,000
200,000
100,000
0
2000
2001
2002
2003
2004
Figure 2. Total HIV/AIDS spending by source, 2000-2004 (in thousand Pesos)
500,000
450,000
400,000
350,000
300,000
250,000
200,000
150,000
100,000
50,000
0
public
external
2000
2001
2002
2003
2004
It can be observed that the share of public sector spending on AIDS in the last
five years is relatively small (15.58% in 2000, a mere 6.47% in 2001 and 21% in 2004).
It should be noted that in recent years, the Philippines has been experiencing fiscal
constraints resulting in limited budget appropriations in nearly all government agencies.
11
A large share of total spending therefore came from external sources (84% in 2000,
85% in 2002, and 79% in 2004).
Figure 3. Distribution of spending by source, 2000-2004 (in %)
120
100
80
60
84.42
93.53
85.39
86.53
2001
2002
2003
78.96
external
public
40
20
0
2000
2004
Public sector sources include national government agencies and the LGUs.
National government spending is mainly from the DOH’s NASPCP and its Centers for
Health Development (CHDs), the PNAC, the DepEd and the DOLE-OHSC, among others.
On the other hand, external sources of financing include: USAID, JICA, Joint UN
Programme on AIDS (UNAIDS), United Nations Population Fund (UNFPA), the German
Development Bank (Kreditanstalt fur Wiederafbau or KfW), among others.
The NGOs usually get funding from external sources as well. The major NGO
players in HIV/AIDS prevention and control activities covered in this report include: RAF,
HAIN, Lunduyan, DKT, Philippine NGO Council (PNGOC), among others.
In terms of financing agents, it can be observed that from 2002 onwards, more
than half of total financing went to non-public agents or NGOs (71% in 2002, 79% in
2003, and 57% in 2004). The effectiveness of NGOs cannot be denied when it comes to
carrying out HIV/AIDS prevention and control activities. This only affirms the importance
of the NGO community in delivering critical services that are best provided by
12
institutions from the community or grassroots level and the government’s recognition of
the need for public-private partnership collaboration in areas where NGOs have
comparative advantage.
Nature of HIV/AIDS Program Spending
With regard to specific activities, it can be observed that in the Philippines,
resources were poured mostly on prevention activities (77.7% in 2000, 65% in 2002 and
62% in 2004). With the low prevalence of HIV/AIDS in the country, efforts were
concentrated on keeping the prevalence low and keeping the rate of transmission slow.
Prevention programs in the country include: IEC, condom social marketing, counseling
and testing, STD management, among others.
Resources were also spent on program costs, which include: advocacy activities,
capability building, monitoring and surveillance, laboratory infrastructure, research and
management costs. Notably, a lot of resources were poured on AIDS program cost in
2001 (61%) largely by donor agencies (USAID and JICA activities).
Although the share of spending for treatment is very low, it can be seen that
from 2002 onwards it is relatively increasing (1% in 2002, 1.14% in 2003 and 2.4% in
2004). These services are limited only to laboratory tests, prophylaxis for OIs and
treatment of opportunistic infections (OIs). Cost of ART is usually borne by the AIDS
patient. Efforts are being done, however, to make ART accessible and affordable.
13
Figure 4. Distribution of spending by nature, 2000-2004 (in %)
90
80
79.84
77.71
65.46
61.38
70
62.3
60
Prev.
50
38.25
40
30
35.33
33.52
21.42
Treat.
Prog.
19.02
20
10
0
2000
2001
2002
2003
2004
Presently, the government does not yet have a specific program for children
orphaned by AIDS. However, regular programs (protective and rehabilitation services)
for children and vulnerable groups in general are being implemented by the DSWD and
some NGOs. There is also no policy on providing additional wage benefits for health
professionals that cater to persons with HIV/AIDS as in other countries.
Detailed breakdown of sources of financing and types of activity are in Annex B
Tables 1 and 2.
Chapter 4 Program and Policy Implications
Generally, more investments are needed in order to halt and reverse the spread
of HIV/AIDS given that the total spending on AIDS seems to be decreasing, and the
number of cases increasing. Although the reported cases are relatively low, the disease
is deemed “hidden and growing” in the Philippines and the conditions for AIDS to “take
off” are present.
14
Based on the Fourth AIDS Medium Term Plan, around PhP275 million is needed
to implement the major strategies and activities in 2005 and 2006. However, based on
the spending assessment for the past five years, the government spends only about
PhP34 million every year (domestic resources). This illustrates the need for more
resources in view of the huge financing gap.
Specifically, resources are needed for preventive interventions so that these can
be improved and expanded. Critical prevention activities should be targeted at highly
vulnerable groups—sex workers and their clients, males having sex with males (MSM),
injecting drug users, and most especially overseas Filipino workers.
Institutional (workplace, school-based) and general public interventions, in
particular must be strengthened. Notably, the enormous size of key population groups
such as workplace population, youth (in-school and out-of-school), etc. requires
substantial amounts of resources to cover essential outreach and information services.
Advocacy and IEC activities aimed at encouraging voluntary counseling and testing must
be implemented in order to determine the real magnitude of the disease in the country.
Treatment, care and support services for people infected and affected with AIDS
must likewise be improved. The means of acquiring less expensive ARV treatment must
be carefully looked into and institutionalized. Management systems in support of the
delivery of HIV/AIDS information and preventive services should be strengthened.
More importantly, resources from the public sector must be used effectively and
efficiently, given financial constraints. Best practice methods in other countries must be
examined for possible adoption or replication in the Philippines. Given the volatility in the
level of resources, the proper mix of interventions in relation to available resources must
be carefully studied so that limited resources are optimized.
Lastly, there is a need to explore the institutionalization of a data collection
system so that HIV/AIDS expenditures (among other things) can be regularly monitored
and programs and projects designed more effectively and efficiently. While the
15
development of a monitoring and evaluation system is in progress, the Philippine
National AIDS Council may want to consider adopting the National AIDS Spending
Assessment (NASA) methodology. If NASA is recommended, it may be necessary to
determine if it fits into the Country Response Information System (CRIS) as this has
been adopted for HIV/AIDS monitoring. Also, there may be a need to harmonize the
type of data to be collected and analyzed, standardize definitions, determine the type of
health care function to be included, and ensure compliance of annual reporting of all
stakeholders.
16
Annexes
Annex A. Detailed methodology
In order to get the data, major stakeholders (government agencies, NGOs, donor
institutions) were requested to fill up two dummy matrices. Government agencies and
NGOs were requested to fill up the first matrix (Dummy Table 1 for Government and
NGOs) which will show the organization’s sources of financing over the last five years
(2000-2004). For each source of financing, the government agencies and NGOs were
requested to fill up a second matrix (Dummy Table 2) to show the various functions or
activities where resources were spent during the same period.
Donor institutions were requested to fill up the first matrix (Dummy Table 1 for
donors) which will show the agents that they provided with financing over the last five
years (2000-2004). Furthermore, for each financing agent or implementing agent, donor
institutions were requested to fill up a second matrix (Dummy Table 2) to show the
functions or activities that they funded.
The accomplished matrices were reviewed to prevent double-counting, after
which, the sets of matrices were consolidated into single table for each year.
I. Primary Data
A. Actual expenditure data (source of financing) were collected through direct
requests from the following donor institutions:
1. USAID
2. UNAIDS
3. Kfw
4. JICA
5. UNICEF
6. EU
7. WHO
8. UNFPA
9. Global Fund sub-principal recipient (PNGOC)
Generally, donor agencies provide sources of financing but the activities are
being implemented by government agencies, LGUs and NGOs. Hence, other
expenditure data of NGOs reflected in this report were actually provided by the
donor institutions (refer to item D).
PNGOC was not able to provide a detailed breakdown of their expenditures by
function. On the other hand, USAID and UNFPA were not able to provide a
detailed breakdown of their expenditures by financing agent.
B. Actual expenditure data were collected from the following government agencies:
1. Department of Labor and Employment - Occupational Health and Safety
Center (DOLE-OHSC)
17
2. Department of Health’s (DOH) National AIDS/STD Prevention and Control
Program (DOH-NASPCP)
3. LGUs: Cagayan de Oro, Urdaneta, Quezon City, Laoag City, General
Santos, San Fernando, Puerto Princesa
C. Actual expenditure data were collected directly from several non-government
organizations:
1. DKT Philippines
2. Remedios AIDS Foundation (RAF)
3. Health Action Information Network (HAIN)
4. Lunduyan
These NGOs provided other sources of financing that were not initially identified
(refer to item E).
D. Other expenditure data on NGOs/agents (recipients of funds) were provided by
donor agencies. These NGO-recipients of donor funds include:
1. AIDS Society of the Philippines (ASP)
2. ACHIEVE
3. Health Educators Association of the Philippines (HEAP)
4. Philippine Business for Social Progress (PBSP)
5. Philippine NGO Support (PHANSUP)
6. Positive Action Foundation Philippines, Inc. (PAFPI)
7. Women’s Health Care Foundation (WHCF)
8. Kabalikat
9. Institute for Social Studies and Action (ISSA)
10. MTV
11. Remedios AIDS Society (RAS)
E. Other sources of financing data were provided by NGOs. These NGO-provided
sources of financing include:
1. Save the Children (US)
2. Save the Children (UK)
3. Ford Foundation
4. Amkor Technology
5. Catholic Agency for Overseas Development (CAFOD, UK)
6. UK HIV/AIDS Alliance
7. British Embassy
8. Christian Aid
9. Plan International
10. Packard Foundation
11. Population Services Int’l. - Dept. for Int’l Dev’t. (PSI DFID)
II. Secondary Data
A. The Policy and Advocacy Efforts publication of the AIDS Surveillance Education
Project (ASEP) of the Program for Appropriate Technology in Health (PATH) was
used for the expenditure data of the following LGUs for the years 2002-2003:
18
1.
2.
3.
4.
5.
6.
7.
8.
Angeles
Pasay
Quezon City
Davao
General Santos
Zamboanga
Iloilo
Cebu.
B. The National Expenditure Program publication of the Department of Budget and
Management (DBM) and the General Appropriations Act were used for the
budget data (2000-2004) of the following:
1. Philippine National AIDS Council (PNAC) Operations
2. Department of Education’s (DepEd) School-based AIDS Education Program
C. Project monitoring documents available at the National Economic and
Development Authority (NEDA) were also reviewed to determine the level of
expenditures for AIDS. Specifically, these included the Women’s Health and Safe
Motherhood Project implemented by DOH and funded by the World Bank (which
included spending on STI management and prevention), and the UNDP-NEDA
project Increasing Awareness and Understanding of the Development
Implications of HIV/AIDS.
III. Imputed data
A.
The DOH’s Centers for Health Development (CHDs) for AIDS/STD Prevention
and Control Program were estimated using key informant interview and
secondary data. Work and financial plans of CHDs were reviewed to
determine the average budget allocation for STD/AIDS activities in the
regions. Around 1.15 percent of total health operations budget of each CHD
is assumed to be allocated for STD/AIDS activities. Health operations budget
data was taken from National Expenditure Program document of the
Department of Budget and Management. It is further assumed that around
60 percent of STD/AIDS budget of the CHD is for prevention activities and
the rest are for program support activities;
B.
Expenditures of the Research Institute for Tropical Medicine (RITM) and San
Lazaro Hospital for treatment services (treatment of OIs, prophylaxis,
laboratory examination) were calculated using the Price-Quantity Approach.
These two public facilities are where most AIDS patients go to for treatment.
Cost data were collected through key informant interview. Total number of
AIDS patients receiving treatment for 2004 was taken from draft Country
Report on UNGASS (2005). According to PAFPI, 53 PLWHAs were receiving
treatment. This figure was used in projecting retrospectively the previous
years’ estimated number of AIDS patient receiving treatment. The following
cost data were used in calculating treatment services spending:
19
1) Cost of CD4 and viral load test is PhP14,000.00 per person per year;
2) Average cost of prophylaxis for OIs is PhP30,147 per person per year
(only costs for the following were considered: PCP, TB, MAC, and
clarithomycin);
3) Average cost of treatment of OIs is PhP5,811 for drugs and medicines
and PhP4,393 for laboratory exam (most common OIs being: PCP,
pulmonary TB and candidiasis). It is further assumed that only half of the
PLWHAs are getting treatment for OIs.
20
Annex B. Tables 1 (by source) and 2 (by function), 2000-2004
21
Annex C. List of Abbreviations
ART
ASP
ASEP
CAFOD
CHD
CHED
CSR
CWC
DBM
DepEd
DFID
DILG
DOH
DOLE
DSWD
EC
ERPAT
FHSIS
FLEMMS
FP
GAA
GAD
GDP
GNP
HAIN
HACT
HIV/AIDS
Syndrome
HDI
IEC
IMR
ISSA
JICA
KFW
LAC
LGC
LGU
MMR
NASPCP
NDHS
NEC
NEDA
NEP
NG
NGA
NGO
anti-retroviral therapy
AIDS Society of the Philippines
AIDS Surveillance Education Project
Catholic Agency for Overseas Development
Center for Health Development
Commission on Higher Education
Cohort Survival Rate
Council for the Welfare of Children
Department of Budget and Management
Department of Education
Department for International Development
Department of Interior and Local Government
Department of Labor and Employment
Department of Social Welfare and Development
European Commission
Empowerment and Re-affirmation of Parental Abilities Training
Field Health Service Information System
Functional Literacy Education and Mass Media Survey
family planning
General Appropriations Act
gender and development
Gross Domestic Product
Gross National Product
Health Action Information Network
Hospital AIDS Core Teams
Human Immunodeficiency Virus/Acquired Immune Deficiency
Human Development Index
information, education and communication
infant mortality rate
Institute for Social Studies and Action
Japan International Cooperation Agency
Kreditanstalt fur Wiederaufbau (German Development Bank)
Local AIDS Council
Local Government Code
Local Government Unit
maternal mortality ratio
National AIDS/STD Prevention and Control Program
National Demographic and Health Survey
National Epidemiology Center
National Economic and Development Authority
National Expenditure Program
National Government
National Government Agencies
22
NHSS
OFWs
OHSC
OI
PAFPI
PBSP
PCP
PHANSuP
PLHWAs
PNAC
PNGOC
PSI
RA
RAF
RITM
SACCL
SAEP
STIs
STD
TFG
TFR
U5MR
UNICEF
UNDP
UNFPA
USAID
WHO
WHCF
National HIV/AIDS Sentinel Surveillance
Overseas Filipino Workers
Occupational Health and Safety Center
opportunistic infection
Positive Action Foundation Philippines, Inc.
Philippine Business for Social Progress
Pneumocystis Carinii Pneumonia
Philippine NGO Support Program
people living with HIV/AIDS
Philippine NGO Council for Population, Health and Welfare
Population Services International
Republic Act
Remedios AIDS Foundation
Research Institute for Tropical Medicine
STD/AIDS Central Cooperative Laboratory
School-based AIDS Education Program
sexually-transmitted infections
sexually-transmitted disease
The Futures Group
total fertility rate
under-five mortality rate
United Nations Children Fund
United Nations Development Programme
United Nations Population Fund
United States Agency for International Development
World Health Organization
Women’s Health Care Foundation
23
Annex D. Selected References
Department of Budget and Management, National Expenditure Program, Manila,
Philippines
Department of Budget and Management, General Appropriations Act, Manila,
Philippines
National Economic and Development Authority (NEDA), 2005, Second Philippine
Progress Report on the Millennium Development Goals, NEDA, Pasig City, Philippines
National Economic and Development Authority (NEDA), 2004, Medium Term Philippine
Development Plan, 2004-2010 (MTPDP), NEDA, Pasig City, Philippines
Department of Health-National Epidemiology Center, HIV/AIDS Registry, Manila,
Philippines
National Statistical Coordination Board, 2005, Philippine National Health Accounts,
Manila, Philippines
National Statistics Office, Census of Housing and Population, Manila, Philippines
Philippine National AIDS Council, 2005, Fourth AIDS Medium Term Plan, 2005-2010,
Manila, Philippines
Program for Appropriate Technology in Health, 2003, Policy and Advocacy Efforts: The
AIDS Surveillance Education Project Experience in the Philippines, USAID, Manila
Philippines
24
Total AIDS spending by source of financing
(in '000)
Source
2000
Government (in Php)
29,286
(in US$)
663
External (in Php)
158,672
(in US$)
3,591
Total (in Php)
187,958
(in US$)
4,253
exchange rate (US$1 = Php 1)
44.19
2001
31,955
627
461,963
9,060
493,918
9,687
50.99
2002
39,625
768
231,500
4,486
271,125
5,254
51.6
2003
35,850
661
230,162
4,247
266,012
4,908
54.2
2004
TOTAL
33,308 170,024
594
125,005 1,207,302
2,231
158,313 1,377,326
2,826
56.03
2001
188,919
3,705
1,841
36
303,158
5,945
493,918
9,687
2002
177,473
3,439
2,779
54
90,873
1,761
271,125
5,254
2003
212,394
3,919
3,024
56
50,594
933
266,012
4,908
2004
TOTAL
98,622 823,469
1,760
3,763
13,044
67
55,928 540,813
998
158,313 1,377,326
2,826
source of exchange rate: Bangko Sentral ng Pilipinas
Total AIDS spending by function
(in '000)
Function/nature
Prevention (in Php)
(in US $)
Treatment (in Php)
(in US$)
Program support costs (in Php)
(in US$)
Total (in Php)
Total (in US$)
2000
146,061
3,305
1,637
37
40,260
911
187,958
4,253
TABLE 1.1
By source and agent
(in Philippine Peso '000)
Year 2000
Financing Agents
Public
DOH
-NASPCP (natl)
-CHDs
-PNAC
-San Lazaro/RITM
-SACCL
-Other
DOLE-OSHC
DepEd
UNDP/NEDA
WB/DOH
Non-public
PATH/USAID
DKT Phils
HAIN
Lunduyan
External
Others/USAID
WHO/USAID
UNFPA
TOTAL
Govt
USAID
Kfw
CAFOD UK
Unicef
Financing Source
Save (US)
Ford F.
UNDP
WB
UNFPA
3,186
4,386
14,685
1,637
3,270
64
2,058
1,989
58,216
3,186
4,386
14,685
1,637
3,270
64
2,058
1,989
58,216
50,515
3,680
50,515
22,777
2,872
6,595
3,680
1,849
13,417
442
187,958
22,777
2,872
1,415
1,500
1,849
13,417
29,286
65,781
22,777
2,872
1,415
1,500
Financing agent - refers to implementing or executing organization.
Public agent - refers to government agencies
Non-public agent - refers to non-government organizations, whether local or foreign
External agent - refers to donor agencies or other implementing agents.
UNFPA usually contracts out activities to government agencies or NGOs. However, this information was not provided by UNFPA
Total
1,989
58,216
442
442
TABLE 1.2
By source and agent
Year 2001
Financing Agents
Public
DOH
-NASPCP (national)
-CHDs
-PNAC
-San Lazaro/RITM
-SACCL
-Other
DepEd
DOLE-OSHC
UNDP/OSHC
JICA/DOH
WB/DOH
Non-public
PATH/USAID
TFG/USAID
FHI/USAID
DKT Phils.
HAIN
Lunduyan
External
WHO/USAID
Others/USAID
UNFPA
TOTAL
Govt
USAID
Kfw
UNDP
JICA
Financing Source
CAFOD UK
Unicef
Save (US)
Ford F.
WB
UNFPA
0
3,414
4,386
13,980
1,841
1,171
5,076
2,058
29
147
236,389
70,322
3,414
4,386
13,980
1,841
1,171
5,076
2,058
29
147
236,389
70,322
54,320
10,198
5,099
2,899
54,320
10,198
5,099
39,007
2,376
5,789
2,899
30,727
5,600
1,989
493,918
39,007
2,376
2,400
490
30,727
5,600
31,955
105,944
39,007
147
236,389
2,376
2,400
490
Total
70,322
1,989
1,989
TABLE 1.3
By source and agent
Year 2002
Financing Agent
Public
DOH
-NASPCP (national)
-CHDs
-PNAC
-San Lazaro/RITM
-SACCL
-Other
DepEd
DOLE-OSHC
Local govt
JICA/DOH
UNDP/OSHC
Non-public
PATH/USAID
FHI/USAID
DKT Phils.
HAIN
Lunduyan
AIDS Society of the Phils
External
Others/USAID
WHO/USAID
UNAIDS
UNFPA
TOTAL
Govt
USAID
Kfw
Packard
PSI DFID
UNDP
JICA
Financing Source
UK Alliance
CAFOD UK
Unicef
Save (US)
Ford
UNAIDS
UNFPA
0
3,386
4,547
13,959
2,070
975
6,808
2,058
55
5,767
9,250
8
3,386
4,547
13,959
2,070
975
6,808
2,058
55
5,767
9,250
8
62,140
37,410
61,134
17,813
62,140
37,410
81,609
287
2,594
6,680
722
2,662
287
2,594
2,675
705
3,300
722
5,814
21,865
77
39,625
127,229
61,134
17,813
2,662
8
9,250
Total
287
2,594
2,675
705
3,300
799
3044
3,044
5,814
21,865
77
3,044
271,125
TABLE 1.4
By source and agent
Year 2003
Financing Agent
Public
DOH
-NASPCP (national)
-CHDs
-PNAC
-San Lazaro/RITM
-SACCL
-Other
DepEd
DOLE-OSHC
Local Govt
Amkor/OSHC
JICA/DOH
Non-public
PATH/USAID
DKT Phils.
HAIN
Lunduyan
ACHIEVE
AIDS Society of the Phils
HEAP
PBSP
PHanSup
PAFPI
WHCF
Kabalikat Foundation
External
WHO/USAID
Others/USAID
UNAIDS
UNFPA
TOTAL
Govt
USAID
Kfw
Packard
PSI-DFID
Amkor
JICA
Financing Source
UK Alliance CAFOD UK British Emb.
Unicef
Save (UK)
Ford
UNAIDS
EU
UNFPA
3,093
2,308
9,543
2,315
1,469
6,881
2,058
86
8,097
3,093
2,308
9,543
2,315
1,469
6,881
2,058
86
8,097
111
1,247
111
1,247
70,068
48,904
30,974
70,068
84,567
639
1,019
4,236
813
352
705
1,003
43,214
190
753
2,710
4,689
287
352
1,019
59
1,200
820
2,157
813
352
705
1,003
379
190
753
2,710
42,835
7,308
5,704
1,241
35,850
83,080
48,904
30,974
4,689
111
1,247
Total
287
1,019
59
1,200
820
2,157
8,498
42,835
4,282
4,282
7,308
5,704
1,241
4,282
266,012
TABLE 1.5
By source and agent
Year 2004
Financing Agent
Public
DOH
-NASPCP (national)
-CHDs
-PNAC
-San Lazaro/RITM
-SACCL
-NEC
-Other
DOLE-OSHC
DepED
CHED
Local Govt
Amkor/OSHC
JICA/DOH
WHO/DOH
Unicef/DepEd
Unicef/CWC/Lunduyan
Unicef/Pasay City (LGU)
Unicef/North Cotabato (LGU)
Non-public
LEAD/USAID
DKT Phils.
ISSA
AIDS Society of the Phils.
MTV (private company)
Remedios AIDS Society
HAIN
Lunduyan
PNGOC
External
UNAIDS
UNFPA
TOTAL
Govt
USAID
Kfw
Packard
Unicef
Amkor
JICA
UK Alliance
Financing Source
Global Fund CAFOD UK Xtian AID
Plan Intl
Save (US) Save (UK)
Ford F.
UNAIDS
WHO
UNFPA
0
2,851
2,191
9,445
2,610
1,198
300
6,173
36
2,058
1,286
5,160
141
286
616
4,872
10,182
1,250
5,000
2,851
2,191
9,445
2,610
1,198
300
6,173
36
2,058
1,286
5,160
141
286
616
4,872
10,182
1,250
5,000
6,594
49,442
6,594
50,662
2,141
2,139
5,000
4,906
998
2,758
3,090
13,465
1,220
2,141
2,139
5,000
4,906
998
756
41
1,961
300
200
600
1,990
13,465
5,883
33,308
6,594
49,442
1,220
35,490
141
286
998
13,465
756
41
300
200
600
1,990
7,844
Total
616
5,022
5,022
5,883
5,022
158,313
Annex B
Annex C AO 2005 0020 Establishing PNBS
Annex D
M & E for GFATM
Annex E A.O. BFAD
Annex I Table 2.1.2
2 Eligibility
2.1.2 Counterpart financing and greater reliance on domestic resources
Please enter information on counterpart financing in table 2.1.2 below if the country(ies) listed above are classified as Lowermiddle income or Upper-middle income.
Non-CCM Applicants do not have to fulfill the counterpart financing requirement.
The table should be filled in for each component included in this proposal. For definitions and details of counterpart financing
requirements, see the Guidelines for Proposals, section 2.1.2.
Important note: The field “Total requested from the Global Fund” in table 2.1.2 below should equal the request in section 5 and
table 5.1 for each corresponding component.
Table 2.1.2 – Counterpart financing
(in US$)
Component
Financing sources
Year 1
HIV/AIDS
Year 2
Year 3
estimate
Year 4
estimate
Year 5
estimate
the Global Fund (A)
[from table 5.1]
4,574,130
2,900,834
3,793,418
3,455,221
3,710,587
Counterpart
program] ª º
5,665,982
5,835,961
6,011,040
6,191,372
6,377,112
as a percentage of
total financing:
[B/(A+B)] x 100 = %
55.33%
66.79%
61.31%
64.18%
63.22%
ª includes budget (Personnel & MOOE) from national , approximate value for local governments, and 3 government loans, namely:
1. Condom social marketing – grant from KfW US $ 12,000,000 from 2005-2010 (taken as 100% HIV Program)
2. Second Women’s Health and Safe Motherhood – loan from WB US $ 32,700,000 (taken as 10% HIV Program)
3. Upgrading of 5 Hospitals, 3 of which are treatment hubs (DMC, Bicol Regional and VSSMMC) – loan from Netherlands (taken as 20% HIV
Program)
ºAssumed a 3% increase per year from Year 1 to Year 5
Proposal_form_cleared_0825
4
Annex F Table 5.1
5.1 Component budget summary
Insert budget information for this component broken down by year and budget category, in table 5.1 below.
(The “Total funds requested from the Global Fund” should be consistent with the amounts entered in table 1.2 relating to this component.)
The budget categories and allowable expenses within each category are defined in the Guidelines for Proposal, section 5.1. The total requested for each year, and for the
program as a whole, must be consistent with the totals provided in sections 5.1.
Table 5.1 – Funds requested from the Global Fund
Year 1
Year 2
Year 3
Year 4
Year 5
Total
Human resources
320,187
324,027
324,027
324,027
324,027
1,616,295
Infrastructure and equipment
984,607
1,460
1,460
1,460
1,460
990,447
Training
532,250
305,042
245,792
178,215
288,720
1,550,019
1,305,876
1,227,876
2,057,876
2,127,876
2,057,876
8,777,380
Drugs
167,994
175,994
291,194
291,194
293,194
1,219,570
Planning and administration
773,131
555,631
466,631
162,247
347,747
2,305,387
4,084,045
2,590,030
3,386,980
3,085,019
3,313,024
16,459,098
490,085
310,804
406,438
370,202
397,563
1,975,092
4,574,130
2,900,834
3,793,418
3,455,221
3,710,587
18,434,190
Commodities and products
Total Program Cost
PR (Management Cost)
Total funds requested from the Global
Fund
78
Annex G Table 1.2
1 Proposal Overview
1.2 Proposal funding summary per component
Funds requested for each component (i.e. HIV/AIDS, tuberculosis and/or malaria) in table 1.2 below must be the
same as the totals of the corresponding component budget in table 5.1.
Table 1.2 – Total funding summary
Total funds requested (US$)
Component
HIV/AIDS
Year 1
Year 2
Year 3
Year 4
Year 5
4,574,130
2,900,834
3,793,418
3,455,221
3,710,587
18,434,190
0
0
0
0
0
0
0
0
0
0
0
0
Tuberculosis
Total
Malaria
Total
1.3 Previous Global Fund grants
Table 1.3 – Previous Global Fund grants
Previous grants
Component
Rounds
Current Amount* (US$)
HIV/AIDS
Round 3 and Round 5
US$ 12,006,887.00
Tuberculosis
Round 2 and Round 5
US$ 58,635,707.50
Malaria
Round 2 and Round 5
US$ 26,138,181.00
HSS/Other
*
Aggregate all past grants, including approved but as yet unsigned amounts. These amounts should include Phase 2
where this has been approved/signed. For more detailed information, see the Guidelines for Proposals, section 1.3.
2
Annex H Table 5.4 By SDA
5.4 Breakdown by service delivery area
Please provide an approximate allocation of the annual budget for each service delivery area (SDA). The objectives and service delivery areas listed should resemble those in
the Targets and Indicators Table (Attachment A to the Proposal Form). It is anticipated that this allocation of the budget across SDAs should be derived from the detailed
component budget (see section 5.2).
Table 5.4: Estimated budget allocation by service delivery area and objective.
Objectives
#1: Increased access of MARPS
and general population to VCT
#1
Year 1
Year 2
Year 3
Year 4
Year 5
94,528
68,160
68,160
68,160
68,160
Prevention: STI diagnosis and treatment
181,784
167,784
181,784
167,784
181,784
#1
Prevention: Testing and Counseling
256,710
155,710
72,460
72,460
42,460
#1
Prevention: PMTCT
21,690
29,690
42,460
1,690
1,690
#1
Information system & Operational research
664,540
315,265
255,265
39,921
270,206
#2: Ensure safe blood supply
Prevention: BCC - Mass media
134,400
106,400
106,400
106,400
106,400
#2
559,350
59,350
59,350
40,000
40,000
#2
Prevention: Blood safety and universal precaution
1,225,119
975,467
1,835,467
1,856,200
1,816,200
#3: Scale up treatment, care and
support
Treatment: Antiretroviral treatment (ARV) and
monitoring
143,400
128,400
1,243,600
243,600
243,600
82,800
85,800
85,800
85,800
87,800
48,000
38,000
48,000
50,000
50,000
12,800
12,800
12,800
12,800
12,800
47,200
47,200
47,200
47,200
47,200
#3
#3
#3
#4: Health systems
strengthening
Treatment: Prophylaxis and treatment for
opportunistic infections
Care and support: Care and support for the
chronically ill
Supportive environment: Stigma reduction in all
settings
Supportive environment: Coordination and
partnership development (national, community,
public-private)
82
Objectives
Supportive environment: Strengthening of civil
Year 1
Year 2
Year 3
Year 4
Year 5
611,724
400,004
371,004
293,004
344,724
NET Total: (No management cost yet)
4,084,045
2,590,030
3,386,980
3,085,019
3,313,024
Total (w/ Management Cost)
4,574,130
2,900,834
3,793,418
3,455,221
3,710,587
#4
83
5.1 Component budget summary
Insert budget information for this component broken down by year and budget category, in table 5.1 below.
(The “Total funds requested from the Global Fund” should be consistent with the amounts entered in table 1.2 relating to this component.)
The budget categories and allowable expenses within each category are defined in the Guidelines for Proposal, section 5.1. The total requested for each year, and for the
program as a whole, must be consistent with the totals provided in sections 5.1.
Table 5.1 – Funds requested from the Global Fund
Year 1
Year 2
Year 3
Year 4
Year 5
Total
Human resources
320,187
324,027
324,027
324,027
324,027
1,616,295
Infrastructure and equipment
984,607
1,460
1,460
1,460
1,460
990,447
Training
532,250
305,042
245,792
178,215
288,720
1,550,019
1,305,876
1,227,876
2,057,876
2,127,876
2,057,876
8,777,380
Drugs
167,994
175,994
291,194
291,194
293,194
1,219,570
Planning and administration
773,131
555,631
466,631
162,247
347,747
2,305,387
4,084,045
2,590,030
3,386,980
3,085,019
3,313,024
16,459,098
490,085
310,804
406,438
370,202
397,563
1,975,092
4,574,130
2,900,834
3,793,418
3,455,221
3,710,587
18,434,190
Commodities and products
Total Program Cost
PR (Management Cost)
Total funds requested from the Global
Fund
78

Proposal Form (R06 - ) (PHL-R06-HA)

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